Healthcare Provider Details

I. General information

NPI: 1124944038
Provider Name (Legal Business Name): BRYCE MICHAEL DOUGLAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W MISSION AVE
BELLEVUE NE
68005-5124
US

IV. Provider business mailing address

2222 DAVENPORT ST APT 1-303
OMAHA NE
68102-1253
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-5842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8233
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: