1700052487 NPI number — FAMILY FIRST DENTAL ASSOCIATES OF WAUSA P.C.

Table of content: (NPI 1700052487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700052487 NPI number — FAMILY FIRST DENTAL ASSOCIATES OF WAUSA P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FIRST DENTAL ASSOCIATES OF WAUSA P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY 1ST DENTAL OF LAUREL
Provider Other Organization Name Type Code:
3
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:
1700052487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 E. 2ND ST. BOX 488
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68745-1990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-256-3231
Provider Business Mailing Address Fax Number:
402-256-9535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 E. 2ND ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68745-1990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-256-3231
Provider Business Practice Location Address Fax Number:
402-256-9535
Provider Enumeration Date:
05/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STOLTENBERG
Authorized Official First Name:
ANN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
FAMILY 1ST DENTAL SUPPORT MANAGER
Authorized Official Telephone Number:
712-830-5356

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com