Healthcare Provider Details

I. General information

NPI: 1427042746
Provider Name (Legal Business Name): ANGELI JAYESH THAKKER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 S 42ND ST
BELLEVUE NE
68123-1026
US

IV. Provider business mailing address

11511 S 42ND ST
BELLEVUE NE
68123-1026
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-5400
  • Fax: 402-291-5401
Mailing address:
  • Phone: 402-291-5400
  • Fax: 402-291-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6301
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: