Healthcare Provider Details

I. General information

NPI: 1902726243
Provider Name (Legal Business Name): WDL OMAHA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 N 91ST AVE STE B
OMAHA NE
68134-2749
US

IV. Provider business mailing address

5200 N 91ST AVE STE B
OMAHA NE
68134-2749
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-1867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: BRENT RISING
Title or Position: MANAGER
Credential:
Phone: 701-799-6453