| South Omaha Dental Group | |
|
5360 S 72nd St Ralston NE 68127-2876 | |
| (402) 733-4441 | |
| (402) 733-5863 |
| Full Name | South Omaha Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 5360 S 72nd St, Ralston, Nebraska |
| Authorized Official Name and Position | Frank Norman Varon (OWNER) |
| Authorized Official Contact | 4027334441 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Omaha Dental Group 5360 S 72nd St Ralston NE 68127-2876 Ph: (402) 733-4441 | South Omaha Dental Group 5360 S 72nd St Ralston NE 68127-2876 Ph: (402) 733-4441 |
| NPI Number | 1881608156 |
|---|---|
| Provider Enumeration Date | 07/29/2006 |
| Last Update Date | 06/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881608156 | NPI | - | NPPES |
| 5530 | Other | NE | NE BCBS |
| 470080530100 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5826 (Nebraska) | Primary |