Provider Demographics
NPI:1033109665
Name:FURMANSKI, MICHAEL ALLEN SR (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:FURMANSKI
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:302 S BAILEY AVE
Mailing Address - Street 2:PO BOX 1575
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5407
Mailing Address - Country:US
Mailing Address - Phone:308-532-0427
Mailing Address - Fax:308-532-9410
Practice Address - Street 1:302 S BAILEY AVE
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5407
Practice Address - Country:US
Practice Address - Phone:308-532-0427
Practice Address - Fax:308-532-9410
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4479122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47061846200Medicaid