Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4262 | NE |
NPI | 1043499387 |
---|---|
Provider Name | Dr. John Keith Pershing JR. |
First Address | Hastings, NE 68901-5210 |
Second Address | Hastings, NE 68901-5210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2007 |
Last Update Date | 02/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47-057524801 | (05) | NE |