Provider Demographics
NPI:1538182738
Name:SESEMANN, MICHAEL RAY (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAY
Last Name:SESEMANN
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 1:10020 NICHOLAS ST
Mailing Address - Street 2:#200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2088
Mailing Address - Country:US
Mailing Address - Phone:402-392-2880
Mailing Address - Fax:402-392-0729
Practice Address - Street 1:10020 NICHOLAS ST
Practice Address - Street 2:#200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2088
Practice Address - Country:US
Practice Address - Phone:402-392-2880
Practice Address - Fax:402-392-0729
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice