Individual
SUSAN MARIE NILES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14707 CALIFORNIA STREET, SEVILLE SQUARE OFFICE BUILDING SUITE 15, OMAHA, NE 68154-1900
(402) 498-0777
(402) 498-0853
Mailing address
14707 CALIFORNIA STREET, SEVILLE SQUARE OFFICE BUILDING SUITE 15, OMAHA, NE 68154-1900
(402) 498-0777
(402) 498-0853
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5335
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
470727849
BLUE CROSS BLUE SHIELD IN
NE
Enumeration date
03/14/2007
Last updated
08/01/2023
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