Healthcare Provider Details

I. General information

NPI: 1215326558
Provider Name (Legal Business Name): BRONSEN SCHLIEP DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 12/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 O ST STE 1
LINCOLN NE
68510-1532
US

IV. Provider business mailing address

313 W 38TH ST
SCOTTSBLUFF NE
69361-4770
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-6666
  • Fax: 402-475-9327
Mailing address:
  • Phone: 308-630-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6897
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: