Healthcare Provider Details

I. General information

NPI: 1629173828
Provider Name (Legal Business Name): JAMES BRYAN HOHENSTEIN II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17935 WELCH PLAZA SUITE 104
OMAHA NE
68135
US

IV. Provider business mailing address

6801 S 180TH ST STE 104
OMAHA NE
68135-3264
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-5535
  • Fax: 402-330-5543
Mailing address:
  • Phone: 402-330-5535
  • Fax: 402-330-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6331
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: