Individual
JACOB COPENHAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11110 FORT ST STE 106, OMAHA, NE 68164-2183
(402) 492-8300
Mailing address
2817 N 66TH AVE, OMAHA, NE 68104-3927
(402) 215-1165
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7959
NE
Other
Enumeration date
08/07/2023
Last updated
08/07/2023
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