Healthcare Provider Details

I. General information

NPI: 1639762560
Provider Name (Legal Business Name): REBECCA R KRUEGER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S 40TH ST STE 218
LINCOLN NE
68506-5247
US

IV. Provider business mailing address

1919 S 40TH ST STE 218
LINCOLN NE
68506-5247
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-1054
  • Fax: 402-892-7054
Mailing address:
  • Phone: 402-483-1054
  • Fax: 402-892-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: REBECCA R KRUEGER
Title or Position: OWNER
Credential: DDS
Phone: 402-483-1054