1851459721 NPI number — MR. GREGORY E UTECHT DDS

Table of content: MR. GREGORY E UTECHT DDS (NPI 1851459721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851459721 NPI number — MR. GREGORY E UTECHT DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UTECHT
Provider First Name:
GREGORY
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851459721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 NORTH 44TH STREET
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-477-3456
Provider Business Mailing Address Fax Number:
402-477-4504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 NORTH 44TH STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-477-3456
Provider Business Practice Location Address Fax Number:
402-477-4504
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100250911 00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326330 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47009 . This is a "AMERITAS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 65978 . This is a "METLIFE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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