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General NPI Number Information
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NPI Number | 1912079781
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Entity Type | Organization
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Legal Business Name | PIONEER WOODS DENTAL LLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4210 PIONEER WOODS DRIVE SUITE D
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City | LINCOLN
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State | NE
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Zip | 68506
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Country | US
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Telephone | 402-484-6042
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Fax | 402-484-6043
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Provider Business Mailing Address
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Address Line | POB 87 314 N 4TH ST
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City | NEWMAN GROVE
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State | NE
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Zip | 68758-0087
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Country | US
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Telephone | 402-447-6042
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Fax | 402-447-6009
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Authorized Official
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Title or Position | MANAGER
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Name | EDWARD EUGENE QUINCY
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Credential | DDS
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Telephone | 402-447-6042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5876
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License Number State | NE
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