MEDICARE: DR. TODD S WRAGGE DDS

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	1223G0001X	General Practice Dentistry	6197	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7254	OTHER	NE	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730386095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD S WRAGGE DDS

Provider Business Mailing Address
First Line	:	102 E MAIN ST
Second Line	:
City	:	PIERCE
State	:	NE
Zip	:	68767-1344
Country	:	US
Telephone Number	:	402-329-6850
Fax Number	:	402-329-4912

Provider Business Practice Location Address
First Line	:	102 E MAIN ST
Second Line	:
City	:	PIERCE
State	:	NE
Zip	:	68767-1344
Country	:	US
Telephone Number	:	402-329-6850
Fax Number	:	402-329-4912

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. TODD S WRAGGE DDS” Practice Location

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