Healthcare Provider Details

I. General information

NPI: 1700180452
Provider Name (Legal Business Name): VILLAGE POINTE ORAL SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17404 BURKE ST
OMAHA NE
68118-2233
US

IV. Provider business mailing address

17404 BURKE ST
OMAHA NE
68118-2233
US

V. Phone/Fax

Practice location:
  • Phone: 402-317-5657
  • Fax:
Mailing address:
  • Phone: 402-317-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number6728
License Number StateNE

VIII. Authorized Official

Name: DR. MICHAEL I SHNAYDER
Title or Position: PRESIDENT
Credential: D.D.S., M.D.
Phone: 402-317-5657