Provider Demographics
NPI:1598185878
Name:STAMM, MARJEAN MARIE (RDH, BSDH, PHRDH)
Entity Type:Individual
Prefix:MRS
First Name:MARJEAN
Middle Name:MARIE
Last Name:STAMM
Suffix:
Gender:F
Credentials:RDH, BSDH, PHRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 N 164TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2504
Mailing Address - Country:US
Mailing Address - Phone:402-657-1802
Mailing Address - Fax:
Practice Address - Street 1:656 N 164TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2504
Practice Address - Country:US
Practice Address - Phone:402-657-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1367124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist