Provider Demographics
NPI:1831158724
Name:THOMAS J HUERTER DDS MS PC
Entity type:Organization
Organization Name:THOMAS J HUERTER DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUERTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS PC
Authorized Official - Phone:402-397-4226
Mailing Address - Street 1:2410 S 73RD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124
Mailing Address - Country:US
Mailing Address - Phone:402-397-4226
Mailing Address - Fax:
Practice Address - Street 1:2410 S 73RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-397-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE48351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47062645600Medicaid