Organization
DRSGM LLC
Active
Other names
Treehouse Pediatric Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAYNA MATTOX DDS (OWNER)
(402) 319-6688
Entity
Organization
Contact information
Practice address
10520 S 204TH ST STE C, GRETNA, NE 68028-4185
(402) 403-6007
(402) 403-1243
Mailing address
10520 S 204TH ST STE C, GRETNA, NE 68028-4185
(402) 403-6007
(402) 403-1243
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10029073600
—
NE
Enumeration date
11/13/2023
Last updated
08/13/2024
Update your record
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