Provider Demographics
NPI:1275677619
Name:OMAHA ENDODONTISTS, P.C.
Entity Type:Organization
Organization Name:OMAHA ENDODONTISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CACI
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:LIEBENTRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-390-2020
Mailing Address - Street 1:600 N 93RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2697
Mailing Address - Country:US
Mailing Address - Phone:402-390-2020
Mailing Address - Fax:402-397-3675
Practice Address - Street 1:600 N 93RD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2697
Practice Address - Country:US
Practice Address - Phone:402-390-2020
Practice Address - Fax:402-397-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE61281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty