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General NPI Number Information
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NPI Number | 1255697231
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Entity Type | Organization
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Legal Business Name | SMILE STATION
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 17935 WELCH PLZ STE 104
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City | OMAHA
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State | NE
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Zip | 68135-3596
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Country | US
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Telephone | 402-330-5535
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Fax | 402-330-5543
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Provider Business Mailing Address
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Address Line | 17935 WELCH PLZ STE 104
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City | OMAHA
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State | NE
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Zip | 68135-3596
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Country | US
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Telephone | 402-330-5535
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Fax | 402-330-5543
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Authorized Official
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Title or Position | CEO
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Name | DR. JAMES BRYAN HOHENSTEIN
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Credential | DDS
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Telephone | 402-330-5535
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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 | 6331
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License Number State | NE
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