Provider Demographics
NPI:1548402480
Name:SCHARDT, DEBRA L (RDH)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:L
Last Name:SCHARDT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5644 ROAD U
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:NE
Mailing Address - Zip Code:68326-4116
Mailing Address - Country:US
Mailing Address - Phone:402-310-4428
Mailing Address - Fax:402-365-4262
Practice Address - Street 1:5644 ROAD U
Practice Address - Street 2:
Practice Address - City:CARLETON
Practice Address - State:NE
Practice Address - Zip Code:68326-4116
Practice Address - Country:US
Practice Address - Phone:402-310-4428
Practice Address - Fax:402-365-4262
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1024124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025706700Medicaid