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General NPI Number Information
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NPI Number | 1063073898
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Entity Type | Individual
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Provider Name | SOFIA IRIBARREN DDS
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 8200 DODGE ST
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City | OMAHA
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State | NE
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Zip | 68114-4113
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Country | US
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Telephone | 402-836-9785
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Fax | 402-552-7765
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Provider Business Mailing Address
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Address Line | 8200 DODGE ST
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City | OMAHA
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State | NE
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Zip | 68114-4113
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Country | US
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Telephone | 515-267-0737
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Fax | 402-836-9785
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 8047
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS-09997
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8047
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DDS-09997
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License Number State | IA
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS-09997
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License Number State | IA
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