Provider Demographics
NPI:1710625405
Name:KAUS, MITCHELL RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:RYAN
Last Name:KAUS
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 1:4830 SAINT PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68504-2661
Mailing Address - Country:US
Mailing Address - Phone:402-466-2211
Mailing Address - Fax:
Practice Address - Street 1:4830 SAINT PAUL AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-2661
Practice Address - Country:US
Practice Address - Phone:024-662-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011367122300000X
NE79061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist