Healthcare Provider Details

I. General information

NPI: 1457344178
Provider Name (Legal Business Name): CREIGHTON UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CALIFORNIA PLZ SCHOOL OF DENTISTRY
OMAHA NE
68178-0001
US

IV. Provider business mailing address

2500 CALIFORNIA PLZ SCHOOL OF DENTISTRY
OMAHA NE
68178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-5020
  • Fax: 402-280-5094
Mailing address:
  • Phone: 402-280-5020
  • Fax: 402-280-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNE

VIII. Authorized Official

Name: DR. PAUL C EDWARDS
Title or Position: DIRECTOR
Credential: DDS
Phone: 402-280-5020