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General NPI Number Information
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NPI Number | 1497444657
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Entity Type | Organization
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Legal Business Name | PROFILE ORTHODONTICS OMAHA LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 6909 S 157TH ST STE C
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City | OMAHA
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State | NE
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Zip | 68136-3052
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Country | US
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Telephone | 531-893-2928
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6531
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City | LINCOLN
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State | NE
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Zip | 68506-0531
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Country | US
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Telephone | 531-893-2928
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GRANT ESSINK
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Credential | DDS, MS
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Telephone | 531-893-2928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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