Active NPI
South Lincoln Dental LLC
- General Practice Dentistry
- Lincoln, NE
National Provider Identifier
1922525450
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7178
- Legal business name
- SOUTH LINCOLN DENTAL LLC
- Practice address
- 1265 S Cotner Blvd
Lincoln, NE 68510-4975 - Phone
- (402) 904-6005
- Fax
- (402) 904-6005
- NPI assigned
- Aug 25, 2017
- Organization subpart
- Yes
- Parent organization
- SOUTH LINCOLN DENTAL LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Bonnie L Gall
- Title
- Clinical Coordinator
- Phone
- (402) 904-6005
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 7178 | NE | Primary |
Addresses
Primary practice location
1265 S Cotner Blvd
Lincoln, NE 68510-4975
Mailing address
Williamsburg Dental South Street
6930 L Street Suite B
Lincoln, NE 68510
Phone (402) 904-6005
Other practice location 1
2746 South St
Lincoln, NE 68502-3252
Phone (402) 440-4938
Other names 1
- Williamsburg Dental - South Street
National Provider Directory
National Provider Directory- Part of
- South Lincoln Dental LLC
Locations
2746 South St
Lincoln, NE 68502
Phone (402) 440-4938
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503619200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1521244800000",
"number": "1922525450",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "WILLIAMSBURG DENTAL SOUTH STREET",
"address_2": "6930 L STREET SUITE B",
"city": "LINCOLN",
"state": "NE",
"postal_code": "68510",
"telephone_number": "402-904-6005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1265 S COTNER BLVD",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685104975",
"telephone_number": "402-904-6005",
"fax_number": "402-904-6005"
}
],
"practiceLocations": [
{
"address_1": "2746 South St",
"address_purpose": "LOCATION",
"city": "Lincoln",
"state": "NE",
"postal_code": "685023252",
"country_code": "US",
"telephone_number": "402-440-4938",
"fax_number": "402-939-0035",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "SOUTH LINCOLN DENTAL LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SOUTH LINCOLN DENTAL LLC",
"enumeration_date": "2017-08-25",
"last_updated": "2018-03-17",
"status": "A",
"authorized_official_last_name": "GALL",
"authorized_official_first_name": "BONNIE",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "CLINICAL COORDINATOR",
"authorized_official_telephone_number": "402-904-6005"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "NE",
"license": "7178",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Williamsburg Dental - South Street",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Williamsburg Dental - South Street",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.