Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7725 | NE |
NPI | 1063081115 |
---|---|
Provider Name | Dr. Grace Dickerman |
First Address | Lincoln, NE 68521-4560 |
Second Address | Omaha, NE 68198-0600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2021 |
Last Update Date | 23/06/2021 |