Organization
DENTAL SPECIALTIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE MICHAEL RAKES D.D.S. (OWNER)
(402) 895-1900
Entity
Organization
Contact information
Practice address
14133 Q ST, OMAHA, NE 68137
(402) 895-1900
(402) 895-5726
Mailing address
14133 Q ST, OMAHA, NE 68137
(402) 895-1900
(402) 895-5726
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
6712
NE
1223P0221X
Pediatric Dentistry
Primary
4879
NE
1223P0221X
Pediatric Dentistry
6335
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025232300
—
NE
Enumeration date
02/18/2010
Last updated
02/18/2010
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