Healthcare Provider Details

I. General information

NPI: 1568742765
Provider Name (Legal Business Name): NORMAN M. SHELDON, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 W CENTER RD SUITE 110
OMAHA NE
68144-3969
US

IV. Provider business mailing address

12100 W CENTER RD SUITE 110
OMAHA NE
68144-3969
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-5080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: NORMAN SHELDON
Title or Position: OWNER
Credential:
Phone: 402-330-5080