Individual
DR. JASON BRADFORD UNTRAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
4014 LEAVENWORTH ST, OMAHA, NE 68105-1053
(402) 559-5999
(402) 559-3499
Mailing address
988102 NEBRASKA MEDICAL CTR, OMAHA, NE 68198-8102
(402) 559-5999
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
25465
NE
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
25465
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25465
NE LICENSE
NE
Enumeration date
07/15/2008
Last updated
03/29/2018
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