NPIMap

Organization Active NPI

Wahoo Dental Associates, P.C.

  • General Practice Dentistry
  • Wahoo, NE
National Provider Identifier
1033123336
Registry record updated Apr 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6253 Issued in NE
Legal business name
WAHOO DENTAL ASSOCIATES, P.C.
Practice address
357 E 4TH St
Wahoo, NE 68066-1920
Phone
(402) 443-5959
NPI assigned
Jul 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jason P. Glock, D.D.S.NPI 1871778423
Title
Partner
Phone
(402) 443-5959

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 6253 NE Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 6635 NE

Addresses

Primary practice location

357 E 4TH St
Wahoo, NE 68066-1920

Mailing address

357 E 4TH St
Wahoo, NE 68066-1920
Phone (402) 443-5959

Other identifiers 1

IdentifierTypeStateIssuer
10025583000MedicaidNE

National Provider Directory

National Provider Directory

Locations

357 E 4th St
Wahoo, NE 68066
Phone (402) 443-5959

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428019200000",
    "number": "1033123336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 E 4TH ST",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "680661920",
            "telephone_number": "402-443-5959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 E 4TH ST",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "680661920",
            "telephone_number": "402-443-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAHOO DENTAL ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2015-04-03",
        "status": "A",
        "authorized_official_last_name": "GLOCK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "402-443-5959",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "6253",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "6635",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025583000",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wahoo, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.