Healthcare Provider Details

I. General information

NPI: 1700014354
Provider Name (Legal Business Name): JAMIE LYNN BASS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LYNN SCHWANINGER DDS

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N 168TH ST
OMAHA NE
68116-3203
US

IV. Provider business mailing address

1620 RIVERS BND APT 407
WAUWATOSA WI
53226-3066
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-5535
  • Fax: 414-266-5677
Mailing address:
  • Phone: 402-770-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7030-15
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6766
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: