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General NPI Number Information
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NPI Number | 1417216722
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Entity Type | Organization
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Legal Business Name | DR. MARK VANICEK
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Dates
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Enumeration Date | 05/07/2012
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 6101 VILLAGE DR STE 102
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City | LINCOLN
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State | NE
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Zip | 68516-5830
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Country | US
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Telephone | 402-420-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 7621 KENNELLEY DR
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City | LINCOLN
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State | NE
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Zip | 68516-3797
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Country | US
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Telephone | 402-420-2600
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | MARK VANICEK
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Credential |
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Telephone | 402-420-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5311
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License Number State | NE
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