Active NPI
Greg Stuart Samuelson, D.D.S. M.S.D.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Omaha, NE
National Provider Identifier
1316051469
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 5341
- Practice address
- 13808 W Maple Rd
Suite 112
Omaha, NE 68164-6231 - Phone
- (402) 493-2268
- Fax
- (402) 445-8370
- NPI assigned
- Aug 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 5341 | NE | Primary |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 7681 | IA |
Addresses
Primary practice location
13808 W Maple Rd
Suite 112
Omaha, NE 68164-6231
Mailing address
13808 W Maple Rd
Suite 112
Omaha, NE 68164-6231
Phone (402) 493-2268
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025140300 | Medicaid | NE | |
| 1225359 | Medicaid | IA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 7681 | IA | MD | General Practice Dentistry |
| 5341 | NE | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hillsborough Family Dentistry, P.C. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Dentistry
- Omaha, NE
- NPI 1811088693
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1316051469",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13808 W MAPLE RD",
"address_2": "SUITE 112",
"city": "OMAHA",
"state": "NE",
"postal_code": "681646231",
"telephone_number": "402-493-2268",
"fax_number": "402-445-8370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13808 W MAPLE RD",
"address_2": "SUITE 112",
"city": "OMAHA",
"state": "NE",
"postal_code": "681646231",
"telephone_number": "402-493-2268",
"fax_number": "402-445-8370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUELSON",
"first_name": "GREG",
"middle_name": "STUART",
"name_prefix": "Dr.",
"credential": "D.D.S. M.S.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-18",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NE",
"license": "5341",
"primary": true
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IA",
"license": "7681",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025140300",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1225359",
"state": "IA"
}
],
"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 Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.