Healthcare Provider Details

I. General information

NPI: 1952021537
Provider Name (Legal Business Name): MIDWEST ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 CALIFORNIA ST STE 220
OMAHA NE
68154-5248
US

IV. Provider business mailing address

13500 CALIFORNIA ST STE 220
OMAHA NE
68154-5248
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-9887
  • Fax:
Mailing address:
  • Phone: 402-398-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: BRENDA HOPPE
Title or Position: OFFICE MANAGER
Credential:
Phone: 402-398-9887