| Miboca 1 LLC | |
|
5305 S 96th St Omaha NE 68127-3317 | |
| (402) 331-0701 | |
| (402) 331-7130 |
| Full Name | Miboca 1 LLC |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 5305 S 96th St, Omaha, Nebraska |
| Authorized Official Name and Position | Rafaela Monica Romero (MANAGER) |
| Authorized Official Contact | 4023310701 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Miboca 1 LLC 5305 S 96th St Omaha NE 68127-3317 Ph: (402) 331-0701 | Miboca 1 LLC 5305 S 96th St Omaha NE 68127-3317 Ph: (402) 331-0701 |
| NPI Number | 1043818438 |
|---|---|
| Provider Enumeration Date | 10/16/2020 |
| Last Update Date | 10/16/2020 |
| Certification Date | 10/16/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043818438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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