Healthcare Provider Details

I. General information

NPI: 1770156796
Provider Name (Legal Business Name): KRISTIN SOE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 E 23RD ST
FREMONT NE
68025-2433
US

IV. Provider business mailing address

4410 S 218TH ST
ELKHORN NE
68022-3316
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-9100
  • Fax:
Mailing address:
  • Phone: 308-352-6425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37550
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: