MEDICARE: TRACY HEGEHOLZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7726	NE
2	1223P0221X	Pediatric Dentistry	7726	NE

General Provider Information

NPI Number	:	1073181327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY HEGEHOLZ DDS

Provider Business Mailing Address
First Line	:	1140 N 83RD ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-2080
Country	:	US
Telephone Number	:	402-483-4322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 N 83RD ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68505-2080
Country	:	US
Telephone Number	:	402-483-4322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	07/25/2024

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Directions to “ TRACY HEGEHOLZ DDS” Practice Location

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