| Advanced Dentistry | |
|
11919 Grant St Suite 140 Omaha NE 68164-3475 | |
| (402) 493-4175 | |
| (402) 493-9273 |
| Full Name | Advanced Dentistry |
|---|---|
| Speciality | Clinic/Center |
| Location | 11919 Grant St, Omaha, Nebraska |
| Authorized Official Name and Position | Jody M Schmid (OFFICE MANAGER) |
| Authorized Official Contact | 4024934175 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Dentistry 11919 Grant St Suite 140 Omaha NE 68164-3475 Ph: (402) 493-4175 | Advanced Dentistry 11919 Grant St Suite 140 Omaha NE 68164-3475 Ph: (402) 493-4175 |
| NPI Number | 1598998940 |
|---|---|
| Provider Enumeration Date | 09/02/2009 |
| Last Update Date | 09/16/2010 |
| Medicare PECOS PAC ID | 7315092863 |
|---|---|
| Medicare Enrollment ID | O20090904000137 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598998940 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 4339 (Nebraska) | Primary |
| Provider Name | Roger W Roubal |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1215014998 PECOS PAC ID: 8426055302 Enrollment ID: I20061107000482 |
| Provider Name | John J Otten |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1902930159 PECOS PAC ID: 8820155088 Enrollment ID: I20170927001613 |
| Provider Name | Phillip Tracy Brigden |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1013297332 PECOS PAC ID: 8426308545 Enrollment ID: I20181009000960 |
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