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General NPI Number Information
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NPI Number | 1710601422
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Entity Type | Organization
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Legal Business Name | PEARL DENTISTRY OMAHA, LLC
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 7302 GILES RD STE 1
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City | LA VISTA
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State | NE
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Zip | 68128-5902
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Country | US
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Telephone | 402-218-4220
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Fax |
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Provider Business Mailing Address
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Address Line | 7302 GILES RD STE 1
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City | LA VISTA
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State | NE
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Zip | 68128-5902
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Country | US
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Telephone | 402-218-4220
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Fax | 402-218-4290
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Authorized Official
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Title or Position | DENTIST
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Name | CHRISTOPHER COOPER
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Credential |
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Telephone | 202-812-9626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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