Provider Demographics
NPI:1194890129
Name:STORMBERG, SCOTT MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MATTHEW
Last Name:STORMBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 GINGER COVE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:NE
Mailing Address - Zip Code:68064-3000
Mailing Address - Country:US
Mailing Address - Phone:402-493-5170
Mailing Address - Fax:
Practice Address - Street 1:2623 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-7013
Practice Address - Country:US
Practice Address - Phone:402-553-8552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47083309600Medicaid