Provider Demographics
NPI:1114432606
Name:SUNDERMAN, LEAH GENENE (RDH)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:GENENE
Last Name:SUNDERMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:HOSKINS
Mailing Address - State:NE
Mailing Address - Zip Code:68740-0131
Mailing Address - Country:US
Mailing Address - Phone:402-318-9818
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 779
Practice Address - Street 2:
Practice Address - City:WISNER
Practice Address - State:NE
Practice Address - Zip Code:68791-0779
Practice Address - Country:US
Practice Address - Phone:402-529-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE135124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist