MEDICARE: MEGHANN MARIE DIETZ D.D.S., M.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6078-015	WI
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	6744	NE

General Provider Information

NPI Number	:	1477700037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGHANN MARIE DIETZ D.D.S., M.S.

Provider Business Mailing Address
First Line	:	121 W MISSION AVE
Second Line	:
City	:	BELLEVUE
State	:	NE
Zip	:	68005-5236
Country	:	US
Telephone Number	:	402-291-0528
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 N 144TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-4715
Country	:	US
Telephone Number	:	402-496-9733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2008
Last Update Date	:	08/22/2023

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