Healthcare Provider Details

I. General information

NPI: 1629158365
Provider Name (Legal Business Name): UNMC COLLEGE OF DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST 2ND FLOOR SPC CHILDREN'S HOSPITAL
OMAHA NE
68114-4113
US

IV. Provider business mailing address

40TH AND HOLDREGE ROOM 2106B
LINCOLN NE
68583-0740
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6100
  • Fax: 402-552-7765
Mailing address:
  • Phone: 402-472-3492
  • Fax: 402-472-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RANDAL L HAACK
Title or Position: ASSISTANT DEAN OF OPERATIONS
Credential: PH.D.
Phone: 402-472-3492