Healthcare Provider Details

I. General information

NPI: 1316999493
Provider Name (Legal Business Name): MIDWEST ORAL & MAXILLOFACIAL SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14625 CALIFORNIA ST
OMAHA NE
68154-1950
US

IV. Provider business mailing address

14625 CALIFORNIA ST
OMAHA NE
68154-1950
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-7777
  • Fax: 402-390-9336
Mailing address:
  • Phone: 402-397-7777
  • Fax: 402-390-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL P. MCDERMOTT
Title or Position: ORAL SURGEON/OWNER
Credential: D.D.S.
Phone: 402-397-7777