MEDICARE: DR. AMY TANEL CHADWELL D.D.S.

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	122300000X	Dentist	6417	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	05273	OTHER	NE	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1710972542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY TANEL CHADWELL D.D.S.

Provider Business Mailing Address
First Line	:	16909 LAKESIDE HILLS PLZ
Second Line	:	STE 111
City	:	OMAHA
State	:	NE
Zip	:	68130-4654
Country	:	US
Telephone Number	:	402-884-1828
Fax Number	:	402-505-9791

Provider Business Practice Location Address
First Line	:	16909 LAKESIDE HILLS PLZ
Second Line	:	STE 111
City	:	OMAHA
State	:	NE
Zip	:	68130-4654
Country	:	US
Telephone Number	:	402-884-1828
Fax Number	:	402-505-9791

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	10/24/2008

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