Provider Demographics
NPI:1639762560
Name:REBECCA R KRUEGER DDS PC
Entity Type:Organization
Organization Name:REBECCA R KRUEGER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-483-1054
Mailing Address - Street 1:1919 S 40TH ST STE 218
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5247
Mailing Address - Country:US
Mailing Address - Phone:402-483-1054
Mailing Address - Fax:402-892-7054
Practice Address - Street 1:1919 S 40TH ST STE 218
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5247
Practice Address - Country:US
Practice Address - Phone:402-483-1054
Practice Address - Fax:402-892-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty