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General NPI Number Information
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NPI Number | 1720447444
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Entity Type | Organization
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Legal Business Name | CLABAUGH ORTHODONTICS, LLC
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 1530 S 70TH ST SUITE #201
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City | LINCOLN
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State | NE
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Zip | 68506-1567
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Country | US
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Telephone | 402-483-1009
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Fax |
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Provider Business Mailing Address
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Address Line | 8855 S 33RD ST APT #9-106
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City | LINCOLN
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State | NE
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Zip | 68516-5095
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Country | US
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Telephone | 620-931-7560
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. RICHARD ALLEN CLABAUGH III
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Credential | DDS, MS
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Telephone | 620-931-7560
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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 | 7121
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License Number State | NE
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