| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2456 S 120th St, Omaha, Nebraska |
| Authorized Official Name and Position | Melissa Ryan (HR DIRECTOR) |
| Authorized Official Contact | 6052618167 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2456 S 120th St Omaha NE 68144 Ph: (402) 333-1313 | 2456 S 120th St Omaha NE 68144 Ph: (402) 333-1313 |
| NPI Number | 1184119547 |
|---|---|
| Provider Enumeration Date | 06/28/2018 |
| Last Update Date | 05/27/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184119547 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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