=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649489121
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEJSAR & PEJSAR D.D.S.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 S 40TH ST SUITE #200
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68506-5243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-488-6716
-----------------------------------------------------
Fax | 402-488-6730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1919 S 40TH ST SUITE #200
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68506-5243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-488-6716
-----------------------------------------------------
Fax | 402-488-6730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVEN LYNN PEJSAR
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 402-488-6716
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5367
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------