MEDICARE: DR. STEPHANI JO DALE DDS

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	1223G0001X	General Practice Dentistry	7159	NE

General Provider Information

NPI Number	:	1912312323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANI JO DALE DDS

Provider Business Mailing Address
First Line	:	320 S 51ST ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-3528
Country	:	US
Telephone Number	:	605-359-3036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 CUMING STREET
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68102
Country	:	US
Telephone Number	:	402-280-4586
Fax Number	:

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

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	02/08/2019

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