Individual
JAMIE LYNN REVIELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4001 N 168TH ST, OMAHA, NE 68116-3203
(402) 330-5535
(414) 266-5677
Mailing address
22603 SANCTUARY RIDGE DR, ELKHORN, NE 68022-1300
(402) 770-9119
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
6766
NE
1223P0221X
Pediatric Dentistry
7030-15
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700014354
—
WI
Enumeration date
06/22/2009
Last updated
01/29/2026
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