MEDICARE: DR. ROGER TRENT MINNEMAN D.D.S.

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	4612	NE

General Provider Information

NPI Number	:	1245270941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER TRENT MINNEMAN D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 104
Second Line	:
City	:	WAUNETA
State	:	NE
Zip	:	69045-0104
Country	:	US
Telephone Number	:	308-394-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	639 W LEGION ST
Second Line	:
City	:	WAUNETA
State	:	NE
Zip	:	69045-0104
Country	:	US
Telephone Number	:	308-394-5188
Fax Number	:	308-394-5189

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	12/05/2008

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