Healthcare Provider Details

I. General information

NPI: 1356325146
Provider Name (Legal Business Name): DR HAROLD P KRESKI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7333 FARNAM ST
OMAHA NE
68114-4649
US

IV. Provider business mailing address

7333 FARNAM ST
OMAHA NE
68114-4649
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-4416
  • Fax: 402-397-7282
Mailing address:
  • Phone: 402-397-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3225
License Number StateNE

VIII. Authorized Official

Name: DR. HAROLD PHILLIP KRESKI
Title or Position: PERIODONTIST
Credential: DDS
Phone: 402-397-4416