Healthcare Provider Details

I. General information

NPI: 1750625133
Provider Name (Legal Business Name): JARED R SCHOETTGER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2012
Last Update Date: 11/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 S 13TH ST
LINCOLN NE
68512-9371
US

IV. Provider business mailing address

8000 S 13TH ST
LINCOLN NE
68512-9371
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-8000
  • Fax:
Mailing address:
  • Phone: 402-423-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7050
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: