Provider Demographics
NPI:1245504786
Name:RICHARD T. KRUEGER ET AL PTNR
Entity type:Organization
Organization Name:RICHARD T. KRUEGER ET AL PTNR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-874-2910
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:CHAPPELL
Mailing Address - State:NE
Mailing Address - Zip Code:69129-0468
Mailing Address - Country:US
Mailing Address - Phone:308-874-2910
Mailing Address - Fax:308-874-2459
Practice Address - Street 1:246 VINCENT AVE
Practice Address - Street 2:
Practice Address - City:CHAPPELL
Practice Address - State:NE
Practice Address - Zip Code:69129-9701
Practice Address - Country:US
Practice Address - Phone:308-874-2910
Practice Address - Fax:308-874-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47531223G0001X
NE47561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty