Provider Demographics
NPI:1003855602
Name:STRAUB, PETER ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROY
Last Name:STRAUB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15909 W MAPLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2004
Mailing Address - Country:US
Mailing Address - Phone:402-991-6965
Mailing Address - Fax:
Practice Address - Street 1:15909 W MAPLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-2004
Practice Address - Country:US
Practice Address - Phone:402-991-6965
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE58411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE05489OtherBCBS PROVIDER #
NE969607OtherUNITED CONCORDIA PROVIDER