# DENTAL PROFESSIONALS OF NEBRASKA, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DENTAL PROFESSIONALS OF NEBRASKA, PC
- **Other names:** Lakeside Dental - Omaha
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1952831174
- **Legal business name:** DENTAL PROFESSIONALS OF NEBRASKA, PC
- **Authorized official:** CASSANDRA TEUTSCH (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (217) 540-8972

## Contact information

- **Practice address:** 2505 S 174TH PLZ, OMAHA, NE 68130-2361
- **Practice address phone:** (402) 697-3838
- **Mailing address:** 2505 S 174TH PLZ, OMAHA, NE 68130-2361
- **Mailing address phone:** (402) 697-3838

## Taxonomy

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

## Other

- **Enumeration date:** 06/20/2017
- **Last updated:** 07/21/2022