Provider Demographics
NPI:1932755055
Name:NATION, PHILIP BRADLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BRADLEY
Last Name:NATION
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 S 76TH AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1522
Mailing Address - Country:US
Mailing Address - Phone:918-809-5315
Mailing Address - Fax:
Practice Address - Street 1:3225 OAK VIEW DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5627
Practice Address - Country:US
Practice Address - Phone:918-809-5315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE75871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice