| Innovative Dental, P.c. | |
|
13625 California St Suite 300 Omaha NE 68154-5233 | |
| (402) 933-8005 | |
| (402) 504-1338 |
| Full Name | Innovative Dental, P.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 13625 California St, Omaha, Nebraska |
| Authorized Official Name and Position | Thomas P Berry (OWNER) |
| Authorized Official Contact | 4029338005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Dental, P.c. 13625 California St Suite 300 Omaha NE 68154-5233 Ph: (402) 933-8005 | Innovative Dental, P.c. 13625 California St Suite 300 Omaha NE 68154-5233 Ph: (402) 933-8005 |
| NPI Number | 1932233095 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 05/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932233095 | NPI | - | NPPES |
| 10025440200 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 6521 (Nebraska) | Primary |
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