Provider Demographics
NPI:1275608424
Name:STREVEY, PHILIP E (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:E
Last Name:STREVEY
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12728 AUGUSTA AVE
Mailing Address - Street 2:#110
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3754
Mailing Address - Country:US
Mailing Address - Phone:402-330-1483
Mailing Address - Fax:402-330-6331
Practice Address - Street 1:12728 AUGUSTA AVE
Practice Address - Street 2:#110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3754
Practice Address - Country:US
Practice Address - Phone:402-330-1483
Practice Address - Fax:402-330-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice