Healthcare Provider Details

I. General information

NPI: 1831397389
Provider Name (Legal Business Name): AARON J. ANDERSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989375 NEBRASKA MEDICAL CTR DOC 3615
OMAHA NE
68198-9375
US

IV. Provider business mailing address

800 8TH AVE
PLATTSMOUTH NE
68048-2529
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-6100
  • Fax: 402-559-9607
Mailing address:
  • Phone: 402-201-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD0629
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: