Provider Demographics
NPI:1477686707
Name:BLOME-WUBBELS, SARA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:BLOME-WUBBELS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:BLOME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2710 SOUTH 70TH STREET
Mailing Address - Street 2:STE. 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506
Mailing Address - Country:US
Mailing Address - Phone:402-483-7000
Mailing Address - Fax:402-483-7084
Practice Address - Street 1:2710 SOUTH 70TH STREET
Practice Address - Street 2:STE. 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-483-7000
Practice Address - Fax:402-483-7084
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025401700Medicaid