Healthcare Provider Details

I. General information

NPI: 1376701870
Provider Name (Legal Business Name): PAUL K BEUTLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 SOUTH 30TH STREET SUITE 103
OMAHA NE
68107-1656
US

IV. Provider business mailing address

4920 SO 30TH STREET SUITE 103
OMAHA NE
68107-1656
US

V. Phone/Fax

Practice location:
  • Phone: 402-932-7204
  • Fax: 402-952-1020
Mailing address:
  • Phone: 402-932-7204
  • Fax: 402-502-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6757
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: