NPIMap

Organization Active NPI

Maranatha Dental Group

  • Dentist
  • Lincoln, NE
National Provider Identifier
1972861847
Registry record updated Apr 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4314 Issued in NE
Legal business name
MARANATHA DENTAL GROUP
Practice address
1600 S. 70TH St.
Ste 200
Lincoln, NE 68506-1568
Phone
(402) 489-3837
Fax
(402) 489-3931
NPI assigned
Apr 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Justin T Dworak, DDS
Title
Owner
Phone
(402) 489-3837

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 4314 NE Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 6116 NE

Addresses

Primary practice location

1600 S. 70TH St.
Ste 200
Lincoln, NE 68506-1568

Mailing address

1600 S 70TH St
Ste 200
Lincoln, NE 68506-1568
Phone (402) 489-3837

Other identifiers 1

IdentifierTypeStateIssuer
47063464200MedicaidNE

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335744000000",
    "number": "1972861847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S 70TH ST",
            "address_2": "STE 200",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685061568",
            "telephone_number": "402-489-3837",
            "fax_number": "402-489-3931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S. 70TH ST.",
            "address_2": "STE 200",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685061568",
            "telephone_number": "402-489-3837",
            "fax_number": "402-489-3931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARANATHA DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-30",
        "last_updated": "2012-04-30",
        "status": "A",
        "authorized_official_last_name": "DWORAK",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-489-3837",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NE",
            "license": "4314",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NE",
            "license": "6116",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47063464200",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Apr 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.