Provider Demographics
NPI:1477819563
Name:STEVEN D. WEGNER, D.D.S., P.C.
Entity Type:Organization
Organization Name:STEVEN D. WEGNER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-498-0400
Mailing Address - Street 1:11840 NICHOLAS ST.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154
Mailing Address - Country:US
Mailing Address - Phone:402-498-0400
Mailing Address - Fax:402-498-8583
Practice Address - Street 1:11840 NICHOLAS ST
Practice Address - Street 2:SUITE 210
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4475
Practice Address - Country:US
Practice Address - Phone:402-498-0400
Practice Address - Fax:402-498-8583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN D. WEGNER, D.D.S., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4798332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment