| Adult General Dentistry | |
|
989375 Nebraska Medical Ctr Omaha NE 68198-9375 | |
| (402) 559-6000 | |
| (402) 559-9607 |
| Full Name | Adult General Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 989375 Nebraska Medical Ctr, Omaha, Nebraska |
| Authorized Official Name and Position | Randal L Haack (ASSISTANT DEAN OF OPERATIONS) |
| Authorized Official Contact | 4024723492 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Adult General Dentistry 40th And Holdrege Room 2106b Lincoln NE 68583-0740 Ph: (402) 472-3492 | Adult General Dentistry 989375 Nebraska Medical Ctr Omaha NE 68198-9375 Ph: (402) 559-6000 |
| NPI Number | 1528149580 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 12/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528149580 | NPI | - | NPPES |
| 10025144400 | Medicaid | NE | |
| 1956599 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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