Provider Demographics
NPI:1861476004
Name:DIPRIMA, KATHERINE M (DDS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:DIPRIMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:M
Other - Last Name:DIPRIMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8901 INDIAN HILLS DR STE 300B
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4032
Mailing Address - Country:US
Mailing Address - Phone:402-715-5858
Mailing Address - Fax:402-715-5838
Practice Address - Street 1:8901 INDIAN HILLS DR STE 300B
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4032
Practice Address - Country:US
Practice Address - Phone:402-715-5858
Practice Address - Fax:402-715-5838
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5814OtherBCBS PROVIDER ID
NE1366902OtherUNITED CONCORDIA ID
NE1366902OtherUNITED CONCORDIA ID