Healthcare Provider Details

I. General information

NPI: 1699037564
Provider Name (Legal Business Name): KOLE A. KUGLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 W 37TH ST
KEARNEY NE
68845-0432
US

IV. Provider business mailing address

2907 W 37TH ST
KEARNEY NE
68845-0432
US

V. Phone/Fax

Practice location:
  • Phone: 308-234-3668
  • Fax:
Mailing address:
  • Phone: 308-234-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7007
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: