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General NPI Number Information
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NPI Number | 1831599158
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Entity Type | Organization
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Legal Business Name | DUDZINSKI DENTAL PC
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 17404 BURKE ST
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City | OMAHA
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State | NE
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Zip | 68118-2239
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Country | US
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Telephone | 402-493-2112
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Fax | 402-493-8399
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Provider Business Mailing Address
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Address Line | 2002 VINTON ST
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City | OMAHA
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State | NE
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Zip | 68108-1921
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Country | US
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Telephone | 402-341-5306
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Fax | 402-346-1905
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DARLENE KING
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Credential |
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Telephone | 402-341-5306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5481
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License Number State | NE
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