| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 14202 Y St, Omaha, Nebraska |
| Authorized Official Name and Position | Paul J Sheridan (DENTIST/PRESIDENT) |
| Authorized Official Contact | 4028952085 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
14202 Y St Omaha NE 68137-2862 Ph: (402) 895-2085 | 14202 Y St Omaha NE 68137-2862 Ph: (402) 895-2085 |
| NPI Number | 1083648232 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083648232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 5912 (Nebraska) | Secondary |
| 122300000X | Dentist | 4962 (Nebraska) | Secondary |
| 122300000X | Dentist | 3780 (Nebraska) | Primary |
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