MEDICARE: DR. PETER EDWIN HARBERT DDS, MSD

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	1223P0221X	Pediatric Dentistry	7024	NE
2	122300000X	Dentist	7024	NE

General Provider Information

NPI Number	:	1710249701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER EDWIN HARBERT DDS, MSD

Provider Business Mailing Address
First Line	:	1742 N 175TH PLZ
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68118-6025
Country	:	US
Telephone Number	:	402-490-8425
Fax Number	:

Provider Business Practice Location Address
First Line	:	18101 CHICAGO STREET
Second Line	:	SUITE #107
City	:	OMAHA
State	:	NE
Zip	:	68022
Country	:	US
Telephone Number	:	402-590-5365
Fax Number	:

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

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	06/10/2020

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