Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6203 | NE |
NPI | 1114008943 |
---|---|
Provider Name | Dr. Monte K Zysset |
First Address | Lincoln, NE 68516-6663 |
Second Address | Lincoln, NE 68516-6663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47083316300 | (05) | NE |
7806 | BCBS (01) | |
V10208 | (02) |