Healthcare Provider Details

I. General information

NPI: 1831158724
Provider Name (Legal Business Name): THOMAS J HUERTER DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 S 73RD ST SUITE 101
OMAHA NE
68124
US

IV. Provider business mailing address

2410 S 73RD ST SUITE 101
OMAHA NE
68124
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-4226
  • Fax:
Mailing address:
  • Phone: 402-397-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4835
License Number StateNE

VIII. Authorized Official

Name: DR. THOMAS J HUERTER
Title or Position: OWNER OF CORPORATION
Credential: DDS MS PC
Phone: 402-397-4226