Provider Demographics
NPI:1073789756
Name:FAMILY FIRST DENTAL ASSOCIATES OF WAUSA, P.C.
Entity Type:Organization
Organization Name:FAMILY FIRST DENTAL ASSOCIATES OF WAUSA, P.C.
Other - Org Name:FAMILY 1ST DENTAL OF CREIGHTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY 1ST DENTAL SUPPORT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOLTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-830-5356
Mailing Address - Street 1:615 MAIN ST. BOX 309
Mailing Address - Street 2:
Mailing Address - City:CREIGHTON
Mailing Address - State:NE
Mailing Address - Zip Code:68729-0309
Mailing Address - Country:US
Mailing Address - Phone:402-358-3484
Mailing Address - Fax:402-358-3411
Practice Address - Street 1:615 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CREIGHTON
Practice Address - State:NE
Practice Address - Zip Code:68729-0309
Practice Address - Country:US
Practice Address - Phone:402-358-3484
Practice Address - Fax:402-358-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty