Healthcare Provider Details

I. General information

NPI: 1457472342
Provider Name (Legal Business Name): M.G. DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/24/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 W DODGE RD #201
OMAHA NE
68114-3246
US

IV. Provider business mailing address

9202 W DODGE RD #201
OMAHA NE
68114-3246
US

V. Phone/Fax

Practice location:
  • Phone: 402-558-6220
  • Fax: 402-558-3849
Mailing address:
  • Phone: 402-558-6220
  • Fax: 402-558-3849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER ANNE GREDER
Title or Position: PRACTI
Credential: D.D.S
Phone: 402-558-6220