Provider Demographics
NPI:1720726078
Name:JAMES VINCENT PIETRO DDS
Entity type:Organization
Organization Name:JAMES VINCENT PIETRO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:PIETRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-397-4505
Mailing Address - Street 1:625 N 144TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1935
Mailing Address - Country:US
Mailing Address - Phone:402-397-4505
Mailing Address - Fax:402-397-1751
Practice Address - Street 1:625 N 144TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1935
Practice Address - Country:US
Practice Address - Phone:402-397-4505
Practice Address - Fax:402-397-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental