Healthcare Provider Details

I. General information

NPI: 1215007984
Provider Name (Legal Business Name): ZACHARY LYNN HOUSER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

985163 NEBRASKA MEDICAL CTR
OMAHA NE
68198-5163
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-0643
  • Fax:
Mailing address:
  • Phone: 402-559-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10055
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number361016-9921
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7124
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: