Healthcare Provider Details

I. General information

NPI: 1427285378
Provider Name (Legal Business Name): JON M WASSERBURGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13808 W MAPLE RD
OMAHA NE
68164-6231
US

IV. Provider business mailing address

13808 W MAPLE RD
OMAHA NE
68164-6231
US

V. Phone/Fax

Practice location:
  • Phone: 402-445-4647
  • Fax: 402-445-8370
Mailing address:
  • Phone: 402-445-4647
  • Fax: 402-445-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6852
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: