Provider Demographics
NPI:1902863491
Name:OBRIEN-AUSMAN, KATHLEEN A (DDS)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:OBRIEN-AUSMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 N 146TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-4320
Mailing Address - Country:US
Mailing Address - Phone:402-827-8773
Mailing Address - Fax:
Practice Address - Street 1:15410 WEIR ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-5045
Practice Address - Country:US
Practice Address - Phone:402-933-7100
Practice Address - Fax:402-932-7661
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1394976OtherUNITED CONCORDIA
NE05585OtherBLUE CROSS BLUE SHIELD
NE10025331700Medicaid