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General NPI Number Information
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NPI Number | 1891298196
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Entity Type | Organization
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Legal Business Name | HERGENRADER DENTAL REHAB PC
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 3102 EAST ELK LANE
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City | FREMONT
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State | NE
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Zip | 68025
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Country | US
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Telephone | 315-454-6000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALAN HERGENRADER
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Credential |
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Telephone | 315-454-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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