Provider Demographics
NPI:1588246565
Name:PISKORSKI DENTAL PC
Entity type:Organization
Organization Name:PISKORSKI DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:PISKORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-728-3756
Mailing Address - Street 1:1626 L ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1425
Mailing Address - Country:US
Mailing Address - Phone:308-728-3756
Mailing Address - Fax:308-728-3207
Practice Address - Street 1:1626 L ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1425
Practice Address - Country:US
Practice Address - Phone:308-728-3756
Practice Address - Fax:308-728-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty