MEDICARE: DR. PATRICK WACHTER 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	7093	NE

General Provider Information

NPI Number	:	1598107120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK WACHTER D.D.S

Provider Business Mailing Address
First Line	:	4524 HICKORY ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68106-2510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 L ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68117-1329
Country	:	US
Telephone Number	:	402-731-5423
Fax Number	:

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

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	05/12/2014

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