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General NPI Number Information
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NPI Number | 1609573013
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Entity Type | Organization
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Legal Business Name | ROOTS DENTAL LLC
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 8450 EIGER DR. SUITE 1
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City | LINCOLN
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State | NE
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Zip | 68526
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Country | US
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Telephone | 402-413-6686
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Fax |
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Provider Business Mailing Address
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Address Line | 6171 BLACKSTONE RD
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City | LINCOLN
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State | NE
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Zip | 68526-9539
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Country | US
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Telephone | 701-240-5513
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. AMY WENNINGHOFF
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Credential | DDS
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Telephone | 402-413-6686
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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 |
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License Number State |
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