Individual
DR. GREG STUART SAMUELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S. M.S.D.
Contact information
Practice address
13808 W MAPLE RD, SUITE 112, OMAHA, NE 68164-6231
(402) 493-2268
(402) 445-8370
Mailing address
13808 W MAPLE RD, SUITE 112, OMAHA, NE 68164-6231
(402) 493-2268
(402) 445-8370
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5341
NE
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
7681
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025140300
—
NE
05
—
1225359
—
IA
Enumeration date
08/18/2006
Last updated
07/09/2007
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