Healthcare Provider Details

I. General information

NPI: 1548436223
Provider Name (Legal Business Name): FAMILY FIRST DENTAL ASSOCIATES OF WAUSA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W MAIN ST
HARTINGTON NE
68739-3005
US

IV. Provider business mailing address

103 W MAIN ST
HARTINGTON NE
68739-3005
US

V. Phone/Fax

Practice location:
  • Phone: 402-254-3969
  • Fax:
Mailing address:
  • Phone: 402-254-3969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES S SKOGLUND
Title or Position: OWNER
Credential: DDS
Phone: 402-644-3177