Healthcare Provider Details

I. General information

NPI: 1942345392
Provider Name (Legal Business Name): CACI IRENE LIEBENTRITT D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15808 W DODGE RD STE 101
OMAHA NE
68118-2050
US

IV. Provider business mailing address

15808 W DODGE RD STE 101
OMAHA NE
68118-2050
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:
Title or Position:
Credential:
Phone: