Provider Demographics
NPI:1346343753
Name:SEARS, GREGORY S (MD DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:SEARS
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13215 BIRCH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5431
Mailing Address - Country:US
Mailing Address - Phone:402-390-0770
Mailing Address - Fax:
Practice Address - Street 1:109 N 29TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3261
Practice Address - Country:US
Practice Address - Phone:402-371-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE128851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052802472Medicaid
A54855Medicare UPIN
NE47052802472Medicaid