Healthcare Provider Details

I. General information

NPI: 1407285844
Provider Name (Legal Business Name): SMILE STATION PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 S 180TH ST
OMAHA NE
68135-3264
US

IV. Provider business mailing address

6801 S 180TH ST
OMAHA NE
68135-3264
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-5535
  • Fax:
Mailing address:
  • Phone: 402-330-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6331
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6930
License Number StateNE

VIII. Authorized Official

Name: DR. JAMES BRYAN HOHENSTEIN II
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 402-330-5535