NPIMap

Organization Active NPI

Tiburon Family Dental PC

  • Dentist
  • Omaha, NE
National Provider Identifier
1932214475
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6576 Issued in NE
Legal business name
TIBURON FAMILY DENTAL PC
Practice address
16919 Audrey St
Suite 40
Omaha, NE 68136
Phone
(402) 932-9413
Fax
(402) 505-9704
NPI assigned
Aug 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Robert H Johnson, DDS
Title
President
Phone
(402) 932-9413

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 6576 NE Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 3417859922 UT

Addresses

Primary practice location

16919 Audrey St
Suite 40
Omaha, NE 68136

Mailing address

16919 Audrey St
Suite 40
Omaha, NE 68136
Phone (402) 932-9413

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932214475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16919 AUDREY ST",
            "address_2": "SUITE 40",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68136",
            "telephone_number": "402-932-9413",
            "fax_number": "402-505-9704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16919 AUDREY ST",
            "address_2": "SUITE 40",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68136",
            "telephone_number": "402-932-9413",
            "fax_number": "402-505-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIBURON FAMILY DENTAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-932-9413",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NE",
            "license": "6576",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "UT",
            "license": "3417859922",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Aug 22, 2020; 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.