Individual
SHAYNA L MATTOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
10520 S 204TH ST STE C, GRETNA, NE 68028-4185
(402) 403-6007
(402) 403-1243
Mailing address
18328 TYLER ST, OMAHA, NE 68135-1773
(402) 319-6688
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7643
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0337241
—
OH
05
—
10028122905
—
NE
Enumeration date
05/31/2013
Last updated
08/13/2024
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