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Organization
OMAHA ORAL SURGERY, LLC
Active
Organization
OMAHA ORAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHASE A PRUITT DDS, MD (OWNER)
(507) 316-2205
Entity
Organization
Contact information
Practice address
5040 SO 153RD ST, OMAHA, NE 68137-5067
(507) 316-2205
Mailing address
5040 SO 153RD ST, OMAHA, NE 68137-5067
(507) 316-2205
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
28850
NE
Other
Enumeration date
04/05/2016
Last updated
04/05/2016
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