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2505 S 174th Plz Omaha NE 68130-2361 | |
| (402) 697-3838 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2505 S 174th Plz, Omaha, Nebraska |
| Authorized Official Name and Position | Cassandra Teutsch (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 2175408972 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2505 S 174th Plz Omaha NE 68130-2361 Ph: (402) 697-3838 | 2505 S 174th Plz Omaha NE 68130-2361 Ph: (402) 697-3838 |
| NPI Number | 1952831174 |
|---|---|
| Provider Enumeration Date | 06/20/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952831174 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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