1063699122 NPI number — DR. PETER SARTORI III DDS

Table of content: DR. PETER SARTORI III DDS (NPI 1063699122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063699122 NPI number — DR. PETER SARTORI III DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARTORI
Provider First Name:
PETER
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SARTORI
Provider Other First Name:
PETER
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063699122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 N 44TH
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-466-1121
Provider Business Mailing Address Fax Number:
402-466-1180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N 44TH
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-466-1121
Provider Business Practice Location Address Fax Number:
402-466-1180
Provider Enumeration Date:
01/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6063 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 91184966800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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