MEDICARE: MRS. TERESA M ONDRAK RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	288	NE

General Provider Information

NPI Number	:	1689886715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA M ONDRAK RDH

Provider Business Mailing Address
First Line	:	1511 LIBERTY DR.
Second Line	:
City	:	LEXINGTON
State	:	NE
Zip	:	68850
Country	:	US
Telephone Number	:	308-324-7348
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 5TH STREET
Second Line	:
City	:	OVERTON
State	:	NE
Zip	:	68863-0264
Country	:	US
Telephone Number	:	308-987-2437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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