# INNOVATIVE DENTAL, P.C.

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

## Provider details

- **NPI number:** 1932233095
- **Authorized official:** DR. THOMAS P BERRY D.D.S. (OWNER)
- **Authorized official phone:** (402) 933-8005

## Contact information

- **Practice address:** 13625 CALIFORNIA ST, SUITE 300, OMAHA, NE 68154-5233
- **Practice address phone:** (402) 933-8005
- **Practice address fax:** (402) 504-1338
- **Mailing address:** 13625 CALIFORNIA ST, SUITE 300, OMAHA, NE 68154-5233
- **Mailing address phone:** (402) 933-8005
- **Mailing address fax:** (402) 504-1338

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6521 | NE | Yes |

## Other

- **Enumeration date:** 03/14/2007
- **Last updated:** 05/07/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025440200 | — | NE |