Healthcare Provider Details

I. General information

NPI: 1407471261
Provider Name (Legal Business Name): KATIE KECK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 S 73RD PLZ STE 106
PAPILLION NE
68046-1514
US

IV. Provider business mailing address

7931 ONTARIO ST
OMAHA NE
68124-4066
US

V. Phone/Fax

Practice location:
  • Phone: 402-592-2219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7888
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: