Provider Demographics
NPI:1750273892
Name:OMELCHENKO, NINA (DMD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:OMELCHENKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11336 S 96TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4211
Mailing Address - Country:US
Mailing Address - Phone:402-964-2200
Mailing Address - Fax:
Practice Address - Street 1:11336 S 96TH ST STE 121
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4211
Practice Address - Country:US
Practice Address - Phone:402-964-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist