Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5923 | NE |
NPI | 1194753756 |
---|---|
Provider Name | Dr. Dennis Elof Nilsson |
First Address | Omaha, NE 68164-4244 |
Second Address | Omaha, NE 68164-2677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5923 | DENTAL LICENSE (01) | NE |