Healthcare Provider Details

I. General information

NPI: 1417211210
Provider Name (Legal Business Name): MATTHEW DENNIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE ST
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-5570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28431
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number28431
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number28431
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: