Healthcare Provider Details

I. General information

NPI: 1588580567
Provider Name (Legal Business Name): JOEY CHARLES MACHADO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 PACIFIC ST
OMAHA NE
68154-2863
US

IV. Provider business mailing address

14111 PACIFIC ST
OMAHA NE
68154-2863
US

V. Phone/Fax

Practice location:
  • Phone: 402-896-9112
  • Fax: 402-896-1010
Mailing address:
  • Phone: 402-896-9112
  • Fax: 402-896-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8231
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: