Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 7376 | NE |
NPI | 1083135545 |
---|---|
Provider Name | Dr. Roy S Burkhalter III |
First Address | Lincoln, NE 68512-1152 |
Second Address | Lincoln, NE 68583-0740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2017 |
Last Update Date | 05/07/2017 |