Jamie Lynn Revielle, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

6766 Issued in NE

Practice address

4001 N 168TH St
Omaha, NE 68116-3203

Phone

(402) 330-5535

Fax

(414) 266-5677

NPI assigned

Jun 22, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jamie Lynn Bass Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Smile Station Pediatric Dentistry, North LLC

  • Pediatric Dentistry
  • Omaha, NE
  • NPI 1972148112
  NPD

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

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769644800000",
    "number": "1700014354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22603 SANCTUARY RIDGE DR",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680221300",
            "telephone_number": "402-770-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 N 168TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681163203",
            "telephone_number": "402-330-5535",
            "fax_number": "414-266-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVIELLE",
        "first_name": "JAMIE",
        "middle_name": "LYNN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-22",
        "last_updated": "2026-01-29",
        "certification_date": "2026-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NE",
            "license": "6766",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "7030-15",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700014354",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAMIE",
            "last_name": "BASS",
            "middle_name": "LYNN",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrew Michael Reuss, MD
• Michele A Reuter
• Eleanor Maria Revelis, DDS
• Natalya Revenkov
• Joseph Revers
• Revision Psychotherapy LLC
• Revitalize Chiropractic LLC
• Revival Home Care
• Revive Counseling LLC
• Revive Precision Chiropractic, LLC

• Pediatric Dentistry in Omaha, NE
• Providers in Omaha, NE by specialty
• Pediatric Dentistry in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2026; 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.