Healthcare Provider Details

I. General information

NPI: 1053384198
Provider Name (Legal Business Name): MARK A SCHLOTHAUER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 SAGE ST
GERING NE
69341-3980
US

IV. Provider business mailing address

1270 SAGE ST
GERING NE
69341-3228
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-3196
  • Fax:
Mailing address:
  • Phone: 308-436-3196
  • Fax: 308-436-3197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6371
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: