Provider Demographics
NPI:1326433780
Name:OMAHA ORTHODONTICS LLC
Entity Type:Organization
Organization Name:OMAHA ORTHODONTICS LLC
Other - Org Name:MCINTYRE AND MORRISON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:402-333-5087
Mailing Address - Street 1:17935 WELCH PLZ
Mailing Address - Street 2:#104
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3595
Mailing Address - Country:US
Mailing Address - Phone:402-333-5087
Mailing Address - Fax:402-333-5884
Practice Address - Street 1:17935 WELCH PLZ
Practice Address - Street 2:#104
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-3595
Practice Address - Country:US
Practice Address - Phone:402-333-5087
Practice Address - Fax:402-333-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty