Healthcare Provider Details

I. General information

NPI: 1336376409
Provider Name (Legal Business Name): TYLER L SMITH FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17940 WELCH PLZ SUITE 106
OMAHA NE
68135-3594
US

IV. Provider business mailing address

17940 WELCH PLZ SUITE 106
OMAHA NE
68135-3594
US

V. Phone/Fax

Practice location:
  • Phone: 402-932-9349
  • Fax: 402-505-8503
Mailing address:
  • Phone: 402-932-9349
  • Fax: 402-505-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6822
License Number StateNE

VIII. Authorized Official

Name: DR. TYLER L SMITH
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 402-932-9349