NPIMap

Organization Active NPI

Premier Smile Dental Association PC

  • Dentist
  • Omaha, NE
National Provider Identifier
1942681978
Registry record updated Jun 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7222 Issued in NE
Legal business name
PREMIER SMILE DENTAL ASSOCIATION PC
Practice address
17110 Lakeside Hills PLZ
Omaha, NE 68130-5600
Phone
(402) 300-0506
NPI assigned
Jun 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2015

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

Authorized official

Name
Dr. Stephanie Ebke, DDS
Title
Associate Dentist
Phone
(402) 300-0506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 7222 NE Primary

Addresses

Primary practice location

17110 Lakeside Hills PLZ
Omaha, NE 68130-5600

Mailing address

56470 Highway 4
Daykin, NE 68338-3033
Phone (402) 300-0506

National Provider Directory

National Provider Directory
Tax ID family
Lifetime Family Dental PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1434412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434412800000",
    "number": "1942681978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56470 HIGHWAY 4",
            "city": "DAYKIN",
            "state": "NE",
            "postal_code": "683383033",
            "telephone_number": "402-300-0506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17110 LAKESIDE HILLS PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681305600",
            "telephone_number": "402-300-0506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER SMILE DENTAL ASSOCIATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-16",
        "last_updated": "2015-06-16",
        "status": "A",
        "authorized_official_last_name": "EBKE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "ASSOCIATE DENTIST",
        "authorized_official_telephone_number": "402-300-0506",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NE",
            "license": "7222",
            "primary": true
        }
    ],
    "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 Jun 16, 2015; 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.