Healthcare Provider Details

I. General information

NPI: 1952568693
Provider Name (Legal Business Name): FAMILY FIRST DENTAL ASSOCIATES OF WAUSA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N. STATE ST
OSMOND NE
68765-0250
US

IV. Provider business mailing address

345 N. STATE ST BOX 250
OSMOND NE
68765-0250
US

V. Phone/Fax

Practice location:
  • Phone: 402-748-3713
  • Fax: 402-748-3707
Mailing address:
  • Phone: 402-748-3713
  • Fax: 402-748-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANN L. STOLTENBERG
Title or Position: SUPPORT MANAGER FAMILY 1ST DENTAL
Credential:
Phone: 712-830-5356