Provider Demographics
NPI:1407138415
Name:144TH OMAHA EMERGENCY DENTAL
Entity Type:Organization
Organization Name:144TH OMAHA EMERGENCY DENTAL
Other - Org Name:EMERGENCY DENTAL CARE, USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-597-1186
Mailing Address - Street 1:2605 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3116
Mailing Address - Country:US
Mailing Address - Phone:402-597-1186
Mailing Address - Fax:402-393-2886
Practice Address - Street 1:4267 S 144TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1053
Practice Address - Country:US
Practice Address - Phone:402-597-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty