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17810 Pierce Plaza Suite 100 Omaha NE 68130 | |
| (402) 608-2702 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 17810 Pierce Plaza, Omaha, Nebraska |
| Authorized Official Name and Position | Kendra Walker (CREDENTIALING SUPERVISOR) |
| Authorized Official Contact | 2178217249 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
17810 Pierce Plaza Suite 100 Omaha NE 68130 Ph: () - | 17810 Pierce Plaza Suite 100 Omaha NE 68130 Ph: (402) 608-2702 |
| NPI Number | 1497281745 |
|---|---|
| Provider Enumeration Date | 05/05/2017 |
| Last Update Date | 05/05/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497281745 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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