Provider Demographics
NPI:1912312323
Name:DALE, STEPHANI JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANI
Middle Name:JO
Last Name:DALE
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 1:320 S 51ST ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-3528
Mailing Address - Country:US
Mailing Address - Phone:605-359-3036
Mailing Address - Fax:
Practice Address - Street 1:2901 CUMING STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102
Practice Address - Country:US
Practice Address - Phone:402-280-4586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE71591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice