MEDICARE: DYER'S DENTAL GROUP, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1427876168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYER'S DENTAL GROUP, PC

Provider Business Mailing Address
First Line	:	6606 S 168TH ST STE 100
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-5420
Country	:	US
Telephone Number	:	402-505-6843
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 SW 107TH ST STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-5249
Country	:	US
Telephone Number	:	402-505-6843
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	RIKKI LIEBERTH
Credential	:
Telephone Number	:	402-505-6843

Provider Enumeration Date	:	10/01/2024
Last Update Date	:	10/01/2024

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