Provider Demographics
NPI:1972148112
Name:SMILE STATION PEDIATRIC DENTISTRY, NORTH LLC
Entity Type:Organization
Organization Name:SMILE STATION PEDIATRIC DENTISTRY, NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HOHENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-330-5535
Mailing Address - Street 1:6801 S 180TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3264
Mailing Address - Country:US
Mailing Address - Phone:402-330-5535
Mailing Address - Fax:402-330-5543
Practice Address - Street 1:4001 N 168TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116
Practice Address - Country:US
Practice Address - Phone:402-330-5535
Practice Address - Fax:402-330-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty