Provider Demographics
NPI:1326688193
Name:DENTLINGER, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:DENTLINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 BARADA ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68355-2470
Mailing Address - Country:US
Mailing Address - Phone:402-245-6510
Mailing Address - Fax:402-245-6707
Practice Address - Street 1:3307 BARADA ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:NE
Practice Address - Zip Code:68355-2470
Practice Address - Country:US
Practice Address - Phone:402-245-6510
Practice Address - Fax:402-245-6707
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant