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General NPI Number Information
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NPI Number | 1336673136
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Entity Type | Organization
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Legal Business Name | PRESERVE FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 4303 S 84TH ST
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City | LINCOLN
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State | NE
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Zip | 68516-4403
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Country | US
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Telephone | 402-413-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 4303 S 84TH ST
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City | LINCOLN
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State | NE
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Zip | 68516-4403
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Country | US
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Telephone | 402-413-7000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRADLEY ROLAND ALDERMAN
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Credential | DDS
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Telephone | 402-413-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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