Healthcare Provider Details

I. General information

NPI: 1861897126
Provider Name (Legal Business Name): KORT A. IGEL DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 PACIFIC ST SUITE 200
OMAHA NE
68154-3383
US

IV. Provider business mailing address

10801 PACIFIC ST SUITE 200
OMAHA NE
68154-3383
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-1152
  • Fax: 402-330-3764
Mailing address:
  • Phone: 402-330-1152
  • Fax: 402-330-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KORT ANDREW IGEL
Title or Position: ORTHODONTIST/PRESIDENT
Credential: DDS, MS
Phone: 402-330-1152