Jacob Hustad, DMD
Individual provider Active NPI Dentist · Offutt Afb, NE
NPI 1356895668 · NPPES record last updated Aug 4, 2016
Key facts
- NPI
- 1356895668
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 1001304-15 (WI)
- Practice address
- 2501 Capehart Rd
Offutt Afb, NE 68113-1043 - Phone
- (402) 294-5174
- NPI assigned
- Aug 4, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001304-15 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Evergreen Dental Partners LLC | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1001304-15 | WI | Yes |
Addresses
Primary practice location
2501 Capehart Rd
Offutt Afb, NE 68113-1043
Mailing address
2501 Capehart Rd
Offutt Afb, NE 68113-1043
Phone (402) 294-5174
Other providers in Offutt Afb, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 4, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.