MEDICARE: VILLAGE POINTE ORAL SURGERY P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1306466081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE POINTE ORAL SURGERY P.C.

Provider Business Mailing Address
First Line	:	17121 MARCY ST STE 102
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-3133
Country	:	US
Telephone Number	:	402-317-5657
Fax Number	:	402-317-5647

Provider Business Practice Location Address
First Line	:	17121 MARCY ST STE 102
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-3133
Country	:	US
Telephone Number	:	402-317-5657
Fax Number	:	402-317-5647

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	NICOLE M TOOMBS
Credential	:	MHA
Telephone Number	:	402-317-5657

Provider Enumeration Date	:	04/22/2020
Last Update Date	:	04/22/2020

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