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General NPI Number Information
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NPI Number | 1043178593
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Entity Type | Organization
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Legal Business Name | SA DENTAL LLC
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 14450 EAGLE RUN DR STE 290
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City | OMAHA
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State | NE
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Zip | 68116-1493
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Country | US
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Telephone | 402-964-9009
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Fax |
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Provider Business Mailing Address
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Address Line | 15660 DALLAS PKWY STE 950
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City | DALLAS
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State | TX
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Zip | 75248-3309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | AMANDA LIGHTFOOT
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Credential |
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Telephone | 214-702-0708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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