Provider Demographics
NPI:1497084115
Name:SERGEANT BLUFF DENTAL, PLLC
Entity Type:Organization
Organization Name:SERGEANT BLUFF DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-943-4242
Mailing Address - Street 1:703 1ST ST
Mailing Address - Street 2:PO BOX 280
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-8505
Mailing Address - Country:US
Mailing Address - Phone:712-943-4242
Mailing Address - Fax:712-943-4243
Practice Address - Street 1:703 1ST ST
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-8505
Practice Address - Country:US
Practice Address - Phone:712-943-4242
Practice Address - Fax:712-943-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty