Healthcare Provider Details

I. General information

NPI: 1558350553
Provider Name (Legal Business Name): STEVEN CARL KRUSE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 3RD ST
SEWARD NE
68434-2138
US

IV. Provider business mailing address

111 N 3RD ST
SEWARD NE
68434-2138
US

V. Phone/Fax

Practice location:
  • Phone: 402-643-2931
  • Fax:
Mailing address:
  • Phone: 402-643-2931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4459
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: