Healthcare Provider Details

I. General information

NPI: 1619805538
Provider Name (Legal Business Name): MRS. ANNA M DENTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5189 N 179TH AVE
OMAHA NE
68116-3292
US

IV. Provider business mailing address

7268 PINKNEY ST
OMAHA NE
68134-5125
US

V. Phone/Fax

Practice location:
  • Phone: 402-800-4504
  • Fax:
Mailing address:
  • Phone: 402-320-3156
  • Fax: 402-320-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: