South Omaha Dental Group

Primary specialty

DentistTaxonomy code 122300000X

License

5826 Issued in NE

Legal business name

SOUTH OMAHA DENTAL GROUP

Doing business as

Spring Valley Dental Center

Practice address

5360 S 72ND St
Ralston, NE 68127-2876

Phone

(402) 733-4441

Fax

(402) 733-5863

NPI assigned

Jul 29, 2006

Last updated

Jun 18, 2008By 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

Dr. Frank Norman Varon, D.D.S.

Title

Owner

Phone

(402) 733-4441

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Spring Valley Dental Center Doing business as

Locations

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1881608156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5360 S 72ND ST",
            "city": "RALSTON",
            "state": "NE",
            "postal_code": "681272876",
            "telephone_number": "402-733-4441",
            "fax_number": "402-733-5863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5360 S 72ND ST",
            "city": "RALSTON",
            "state": "NE",
            "postal_code": "681272876",
            "telephone_number": "402-733-4441",
            "fax_number": "402-733-5863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH OMAHA DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "VARON",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "NORMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-733-4441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "5826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470080530100",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NE BCBS",
            "identifier": "5530",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spring Valley Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Ralston, NE
• Providers in Ralston, NE by specialty
• Dentist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.