Healthcare Provider Details

I. General information

NPI: 1952363533
Provider Name (Legal Business Name): KENT R DINUCCI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 Q STREET
OMAHA NE
68127-3673
US

IV. Provider business mailing address

8625 Q STREET
OMAHA NE
68127-3673
US

V. Phone/Fax

Practice location:
  • Phone: 402-331-0221
  • Fax: 402-331-9903
Mailing address:
  • Phone: 402-331-0221
  • Fax: 402-331-9903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number300
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: