=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053489765
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN ROGER LUEHRS D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3350 10TH ST
-----------------------------------------------------
City | GERING
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69341-1724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-632-2279
-----------------------------------------------------
Fax | 308-632-2752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1605 GENTRY BLVD
-----------------------------------------------------
City | GERING
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69341-1959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-632-2279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 6628
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------