Individual
JOSE L IBARROLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
8909 GRANT ST, OMAHA, NE 68134-6161
(402) 572-1120
(402) 572-9059
Mailing address
8909 GRANT ST, OMAHA, NE 68134-6161
(402) 572-1120
(402) 572-9059
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
5780
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04832
BLUECROSS BLUESHIELD ID
NE
01
—
5780
DELTA DENTAL ID
NE
01
—
617646
UNITED CONCORDIA ID
NE
Enumeration date
11/17/2006
Last updated
07/08/2007
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