Provider Demographics
NPI:1295200236
Name:REM DDS PLLC
Entity Type:Organization
Organization Name:REM DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-505-6843
Mailing Address - Street 1:6606 S 168TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-5420
Mailing Address - Country:US
Mailing Address - Phone:402-505-6843
Mailing Address - Fax:
Practice Address - Street 1:28755 SCHOENHERR RD STE 200
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4395
Practice Address - Country:US
Practice Address - Phone:402-505-6843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REM DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-05
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental