Provider Demographics
NPI:1639797194
Name:HOMAN, JARED MATTHEW
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:MATTHEW
Last Name:HOMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11840 NICHOLAS ST STE 210
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4475
Mailing Address - Country:US
Mailing Address - Phone:402-498-0040
Mailing Address - Fax:402-498-8583
Practice Address - Street 1:11840 NICHOLAS ST STE 210
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4475
Practice Address - Country:US
Practice Address - Phone:402-498-0040
Practice Address - Fax:402-498-8583
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7653122300000X
NE07122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist