Provider Demographics
NPI:1447610159
Name:BROZEK, STEPHANIE ROSE (RDH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROSE
Last Name:BROZEK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:MURNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4920 S 30TH ST
Mailing Address - Street 2:SUITE 03
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1590
Mailing Address - Country:US
Mailing Address - Phone:402-932-7204
Mailing Address - Fax:402-952-1020
Practice Address - Street 1:4920 S 30TH ST
Practice Address - Street 2:SUITE 03
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1590
Practice Address - Country:US
Practice Address - Phone:402-932-7204
Practice Address - Fax:402-952-1020
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2115124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist