# FAMILY AND COSMETIC DENTISTRY PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194884296
- **Authorized official:** TIMOTHY RAY ELLIS DDS (PRESIDENT)
- **Authorized official phone:** (402) 334-8208

## Contact information

- **Practice address:** 11836 ELM STREET, SUITE 1, OMAHA, NE 68144-4439
- **Practice address phone:** (402) 334-8208
- **Practice address fax:** (402) 334-1106
- **Mailing address:** 12518 A STREET, OMAHA, NE 68144-4137
- **Mailing address phone:** (402) 330-8216

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 08/01/2012