Provider Demographics
NPI:1619255486
Name:STADLER, ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:STADLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1667
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-1667
Mailing Address - Country:US
Mailing Address - Phone:402-564-4093
Mailing Address - Fax:402-564-4086
Practice Address - Street 1:2457 33RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1309
Practice Address - Country:US
Practice Address - Phone:402-564-4093
Practice Address - Fax:402-564-4086
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1448295OtherUNITED CONCORDIA
MAZ87045OtherBCBS- MASSACHU
NE47083467700Medicaid
NE6248OtherBCBS-NEBRASKA
AL76002976OtherBCBS ALABAMA