Healthcare Provider Details

I. General information

NPI: 1841418084
Provider Name (Legal Business Name): ENDODONTIC SPECIALISTS, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 NICHOLAS ST #201
OMAHA NE
68114-2189
US

IV. Provider business mailing address

10020 NICHOLAS STREET #201
OMAHA NE
68114
US

V. Phone/Fax

Practice location:
  • Phone: 402-614-2024
  • Fax: 402-614-6170
Mailing address:
  • Phone: 402-614-2024
  • Fax: 402-614-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5132
License Number StateNE

VIII. Authorized Official

Name: STEPHEN PRYOR
Title or Position: OWNER
Credential: DDS
Phone: 402-614-2024