MEDICARE: DR. STEPHANIE ANNE VONDRAK 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	1223G0001X	General Practice Dentistry	6373	NE

General Provider Information

NPI Number	:	1326124793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE ANNE VONDRAK D.D.S.

Provider Business Mailing Address
First Line	:	1048 N 204TH AVE
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-4641
Country	:	US
Telephone Number	:	402-289-2313
Fax Number	:	402-289-1516

Provider Business Practice Location Address
First Line	:	1048 N 204TH AVE
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-4641
Country	:	US
Telephone Number	:	402-289-2313
Fax Number	:	402-289-1516

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

Provider Enumeration Date	:	10/28/2006
Last Update Date	:	07/08/2007

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