Healthcare Provider Details

I. General information

NPI: 1306763214
Provider Name (Legal Business Name): TAYLOR DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17455 MANDERSON ST
OMAHA NE
68116-1159
US

IV. Provider business mailing address

17455 MANDERSON ST
OMAHA NE
68116-1159
US

V. Phone/Fax

Practice location:
  • Phone: 402-333-0274
  • Fax: 402-498-2997
Mailing address:
  • Phone: 402-333-0274
  • Fax: 402-498-2997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BRETT H TAYLOR
Title or Position: OWNER
Credential: DDS
Phone: 402-333-0274