Healthcare Provider Details

I. General information

NPI: 1700946464
Provider Name (Legal Business Name): PETER CHRISTOPHER JESSEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5404 AMES AVENUE
OMAHA NE
68104-2884
US

IV. Provider business mailing address

5404 AMES AVENUE
OMAHA NE
68104-2884
US

V. Phone/Fax

Practice location:
  • Phone: 402-451-3126
  • Fax: 402-453-6147
Mailing address:
  • Phone: 402-451-3126
  • Fax: 402-453-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4320
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4320
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: