| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 7930 Drexel St., Omaha, Nebraska |
| Authorized Official Name and Position | Kelley A Barnes (DIRECTOR OF ADMINISTRASTION) |
| Authorized Official Contact | 4029178193 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7930 Drexel St. Omaha NE 68127 Ph: (402) 917-8193 | 7930 Drexel St. Omaha NE 68127 Ph: (402) 917-8193 |
| NPI Number | 1578852083 |
|---|---|
| Provider Enumeration Date | 04/05/2011 |
| Last Update Date | 04/05/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578852083 | NPI | - | NPPES |
| 10025607500 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5109 (Nebraska) | Primary |
| 122300000X | Dentist | 6701 (Nebraska) | Secondary |
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