NPIMap

Organization Active NPI

Innovative Dental, P.C.

  • General Practice Dentistry
  • Omaha, NE
National Provider Identifier
1932233095
Registry record updated May 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6521 Issued in NE
Legal business name
INNOVATIVE DENTAL, P.C.
Practice address
13625 California St
Suite 300
Omaha, NE 68154-5233
Phone
(402) 933-8005
Fax
(402) 504-1338
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2008

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

Authorized official

Name
Dr. Thomas P Berry, D.D.S.NPI 1912237959
Title
Owner
Phone
(402) 933-8005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 6521 NE Primary

Addresses

Primary practice location

13625 California St
Suite 300
Omaha, NE 68154-5233

Mailing address

13625 California St
Suite 300
Omaha, NE 68154-5233
Phone (402) 933-8005

Other identifiers 1

IdentifierTypeStateIssuer
10025440200MedicaidNE

National Provider Directory

National Provider Directory

Locations

13625 California St
Ste 300
Omaha, NE 68154
Phone (402) 933-8005

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210118400000",
    "number": "1932233095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13625 CALIFORNIA ST",
            "address_2": "SUITE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681545233",
            "telephone_number": "402-933-8005",
            "fax_number": "402-504-1338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13625 CALIFORNIA ST",
            "address_2": "SUITE 300",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681545233",
            "telephone_number": "402-933-8005",
            "fax_number": "402-504-1338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DENTAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2008-05-07",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "402-933-8005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NE",
            "license": "6521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025440200",
            "state": "NE"
        }
    ],
    "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 May 7, 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.