Provider Demographics
NPI:1568557817
Name:KENTOPP, NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:KENTOPP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8701 W DODGE RD
Mailing Address - Street 2:STE 409
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3429
Mailing Address - Country:US
Mailing Address - Phone:402-393-7753
Mailing Address - Fax:402-393-7757
Practice Address - Street 1:8701 W DODGE RD
Practice Address - Street 2:STE 409
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3429
Practice Address - Country:US
Practice Address - Phone:402-393-7753
Practice Address - Fax:402-393-7757
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist