Provider Demographics
NPI:1891388138
Name:BENNE, STACY (RDH)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:BENNE
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 1:617 17 RD
Mailing Address - Street 2:
Mailing Address - City:THURSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68062-3050
Mailing Address - Country:US
Mailing Address - Phone:402-380-0653
Mailing Address - Fax:
Practice Address - Street 1:617 17 RD
Practice Address - Street 2:
Practice Address - City:THURSTON
Practice Address - State:NE
Practice Address - Zip Code:68062-3050
Practice Address - Country:US
Practice Address - Phone:402-380-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2133124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist