Provider Demographics
NPI:1295859254
Name:AHLSCHWEDE, JOHN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:AHLSCHWEDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-0407
Mailing Address - Country:US
Mailing Address - Phone:308-946-3059
Mailing Address - Fax:308-946-3472
Practice Address - Street 1:2602 18TH AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-9761
Practice Address - Country:US
Practice Address - Phone:308-946-3059
Practice Address - Fax:308-946-3472
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE42061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025286800Medicaid