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General NPI Number Information
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NPI Number | 1497840623
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Entity Type | Organization
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Legal Business Name | GL MENDLIK DDS PC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1830 N BELL ST
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City | FREMONT
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State | NE
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Zip | 68025-3161
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Country | US
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Telephone | 402-334-2000
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Fax | 402-334-3024
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Provider Business Mailing Address
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Address Line | 17775 MASON STREET STE 2
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City | OMAHA
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State | NE
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Zip | 68118
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Country | US
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Telephone | 402-334-2000
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Fax | 402-334-3024
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK GARRETT MENDLIK
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Credential | DDS MS
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Telephone | 402-334-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 6097
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3648
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License Number State | NE
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