Healthcare Provider Details

I. General information

NPI: 1396735189
Provider Name (Legal Business Name): MICHAEL JOSEPH ATWOOD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART ROAD
OFFUTT AFB NE
68113-2160
US

IV. Provider business mailing address

1904 PETERSEN DR
PAPILLION NE
68046-8060
US

V. Phone/Fax

Practice location:
  • Phone: 402-232-9121
  • Fax:
Mailing address:
  • Phone: 402-232-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI15145
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: