Organization
INNOVATIVE DENTAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS P BERRY D.D.S. (OWNER)
(402) 933-8005
Entity
Organization
Contact information
Practice address
13625 CALIFORNIA ST, SUITE 300, OMAHA, NE 68154-5233
(402) 933-8005
(402) 504-1338
Mailing address
13625 CALIFORNIA ST, SUITE 300, OMAHA, NE 68154-5233
(402) 933-8005
(402) 504-1338
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6521
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025440200
—
NE
Enumeration date
03/14/2007
Last updated
05/07/2008
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