Healthcare Provider Details

I. General information

NPI: 1780752675
Provider Name (Legal Business Name): HENRY ALBERT ST. GERMAIN JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40TH AND HOLDREGE STREET
LINCOLN NE
68583-0750
US

IV. Provider business mailing address

5521 SAWGRASS DR
LINCOLN NE
68526-9232
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-8900
  • Fax:
Mailing address:
  • Phone: 402-472-1278
  • Fax: 402-472-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6004
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: