Healthcare Provider Details

I. General information

NPI: 1982793923
Provider Name (Legal Business Name): MARK DAVID ESSNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15750 W DODGE RD STE 303
OMAHA NE
68118-2535
US

IV. Provider business mailing address

15750 W DODGE RD STE 303
OMAHA NE
68118-2535
US

V. Phone/Fax

Practice location:
  • Phone: 855-965-3636
  • Fax: 877-366-0329
Mailing address:
  • Phone: 855-965-3636
  • Fax: 877-366-0329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6517
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: