Healthcare Provider Details

I. General information

NPI: 1275677619
Provider Name (Legal Business Name): OMAHA ENDODONTISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 02/26/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15808 W. DODGE RD. STE 101
OMAHA NE
68118
US

IV. Provider business mailing address

15808 W. DODGE RD. STE 101
OMAHA NE
68118
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-2020
  • Fax: 402-397-3675
Mailing address:
  • Phone: 402-390-2020
  • Fax: 402-397-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6128
License Number StateNE

VIII. Authorized Official

Name: DR. CACI IRENE LIEBENTRITT
Title or Position: OWNER
Credential: DDS
Phone: 402-390-2020