Provider Demographics
NPI:1043349087
Name:CREIGHTON UNIVERSITY
Entity Type:Organization
Organization Name:CREIGHTON UNIVERSITY
Other - Org Name:CREIGHTON DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:402-280-5065
Mailing Address - Street 1:2500 CALIFORNIA PLZ
Mailing Address - Street 2:SCHOOL OF DENTISTRY
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68178-0001
Mailing Address - Country:US
Mailing Address - Phone:402-280-5065
Mailing Address - Fax:402-280-5013
Practice Address - Street 1:2500 CALIFORNIA PLZ
Practice Address - Street 2:SCHOOL OF DENTISTRY
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68178-0003
Practice Address - Country:US
Practice Address - Phone:402-280-5065
Practice Address - Fax:402-280-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty