Healthcare Provider Details

I. General information

NPI: 1871572594
Provider Name (Legal Business Name): JASON JOHN CARPENTER D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 J F KENNEDY DR
BELLEVUE NE
68005-3639
US

IV. Provider business mailing address

1411 J F KENNEDY DR
BELLEVUE NE
68005-3639
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-3535
  • Fax: 402-291-4001
Mailing address:
  • Phone: 402-291-3535
  • Fax: 402-291-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6399
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: