South 73 Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTH 73 DENTAL LLC

Doing business as

Premier Dental

Practice address

2420 S 73Rd St Ste 300
Omaha, NE 68124-2396

Phone

(402) 391-1919

NPI assigned

Apr 21, 2021

Last updated

Apr 21, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Faith Gaskins

Title

Director of Credentialing

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Other names 1

• Premier Dental Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• James Bruce Lewer, DDS ND

  • Dentist
  • Omaha, NE
  • NPI 1558581637
  NPD (past)

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

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1518549419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2420 S 73RD ST STE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242396",
            "telephone_number": "402-391-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 S 73RD ST STE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681242396",
            "telephone_number": "402-391-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH 73 DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-21",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rasila Soumana Hama, APRN
• Soundmind Therapy Services LLC
• Source One Medical Inc
• Sourcenet, Inc.
• Grace Ellen Sourile, RD
• South Omaha Medical Associates
• South Omaha Surgical Center LLC
• Ian South, MD
• Natasha R Southall
• Southern Sudan Comm Ass

• General Practice Dentistry in Omaha, NE
• Providers in Omaha, NE by specialty
• General Practice Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; 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.