NPIMap

Individual provider Active NPI

Scott Radniecki, DDS

  • Dentist
  • Omaha, NE
National Provider Identifier
1174886675
Registry record updated Apr 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7022 Issued in NE
Practice address
11010 Prairie Brook Rd
Omaha, NE 68144-4841
Phone
(402) 571-3415
Fax
(402) 571-1057
NPI assigned
Jun 19, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 7022 NE Primary

Addresses

Primary practice location

11010 Prairie Brook Rd
Omaha, NE 68144-4841

Mailing address

11010 Prairie Brook Rd
Omaha, NE 68144-4841
Phone (402) 571-3415

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
7022NEMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Gentry Smiles Past Accepting new patients
Sugiko M Reed DDS PC PastSince Oct 15, 2023 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429228800000",
    "number": "1174886675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11010 PRAIRIE BROOK RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681444841",
            "telephone_number": "402-571-3415",
            "fax_number": "402-571-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11010 PRAIRIE BROOK RD",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681444841",
            "telephone_number": "402-571-3415",
            "fax_number": "402-571-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADNIECKI",
        "first_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-19",
        "last_updated": "2015-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "7022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 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.