NPIMap

Organization Active NPI

Dental Professionals of Nebraska, PC

Doing business as Lakeside Dental - Omaha

  • General Practice Dentistry
  • Omaha, NE
National Provider Identifier
1952831174
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
DENTAL PROFESSIONALS OF NEBRASKA, PC
Doing business as
Lakeside Dental - Omaha
Practice address
2505 S 174TH PLZ
Omaha, NE 68130-2361
Phone
(402) 697-3838
NPI assigned
Jun 20, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
DENTAL PROFESSIONALS OF NEBRASKA, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Cassandra Teutsch
Title
Credentialing Coordinator
Phone
(217) 540-8972

Specialties & licenses 1

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

Addresses

Primary practice location

2505 S 174TH PLZ
Omaha, NE 68130-2361

Mailing address

2505 S 174TH PLZ
Omaha, NE 68130-2361
Phone (402) 697-3838

Other names 1

  • Lakeside Dental - Omaha Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dental Professionals of Nebraska PC12 organizations share this tax ID, including this one
Part of
Dental Professionals of Nebraska PC

Other organizations with this tax ID 11

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

Locations

2505 S 174th Plz
Omaha, NE 68130
Phone (402) 697-3838

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1952831174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 S 174TH PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302361",
            "telephone_number": "402-697-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 S 174TH PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302361",
            "telephone_number": "402-697-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENTAL PROFESSIONALS OF NEBRASKA, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DENTAL PROFESSIONALS OF NEBRASKA, PC",
        "enumeration_date": "2017-06-20",
        "last_updated": "2022-07-21",
        "certification_date": "2021-10-27",
        "status": "A",
        "authorized_official_last_name": "TEUTSCH",
        "authorized_official_first_name": "CASSANDRA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-8972"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Dental - Omaha",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 21, 2022; 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.