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General NPI Number Information
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NPI Number | 1588708838
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES - OMAHA, P.C.
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 12/19/2008
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Provider Practice Location Address
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Address Line | 3602 EDGERTON DRIVE
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City | BELLEVUE
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State | NE
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Zip | 68123
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Country | US
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Telephone | 402-731-0989
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Fax |
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Provider Business Mailing Address
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Address Line | 3602 EDGERTON DRIVE
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City | BELLEVUE
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State | NE
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Zip | 68123
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Country | US
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Telephone | 402-731-0989
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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. MIKE O'HARA
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Credential | DDS
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Telephone | 402-731-0989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5337
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License Number State | NE
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