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General NPI Number Information
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NPI Number | 1801165428
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Entity Type | Organization
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Legal Business Name | KRISTEN R. HERMANSEN-RYAN, DDS, P.C.
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 2602 18TH AVE
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City | CENTRAL CITY
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State | NE
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Zip | 68826-9761
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Country | US
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Telephone | 308-946-3059
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Fax | 308-946-3472
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Provider Business Mailing Address
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Address Line | 2602 18TH AVE P.O. BOX 407
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City | CENTRAL CITY
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State | NE
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Zip | 68826-9761
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Country | US
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Telephone | 308-946-3059
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Fax | 308-946-3472
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Authorized Official
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Title or Position | OWNER
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Name | DR. KRISTEN R HERMANSEN-RYAN
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Credential | DDS
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Telephone | 308-946-3059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6693
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License Number State | NE
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