Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6465 | NE |
NPI | 1104082213 |
---|---|
Provider Name | Nicholas Jay Levering |
First Address | Omaha, NE 68178 |
Second Address | Omaha, NE 68178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2008 |
Last Update Date | 29/07/2008 |