Healthcare Provider Details

I. General information

NPI: 1538117106
Provider Name (Legal Business Name): SCOTT PATRICK O'NELE MD, DMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 S 70TH ST SUITE 200
LINCOLN NE
68506-1500
US

IV. Provider business mailing address

1630 S 70TH STREET SUITE 200
LINCOLN NE
68506-1500
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-8787
  • Fax:
Mailing address:
  • Phone: 402-489-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5421
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: