Healthcare Provider Details

I. General information

NPI: 1083304281
Provider Name (Legal Business Name): MACYN BRYNNE BOXBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

17624 OLIVE ST
OMAHA NE
68136-2044
US

V. Phone/Fax

Practice location:
  • Phone: 785-338-1871
  • Fax:
Mailing address:
  • Phone: 785-338-1871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8247
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: