Provider Demographics
NPI:1265795769
Name:CONRAD, KATRINA NICHOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:NICHOLE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:KATRINA
Other - Middle Name:NICHOLE
Other - Last Name:SAEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2115 14TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-1760
Mailing Address - Country:US
Mailing Address - Phone:402-274-3709
Mailing Address - Fax:402-274-4230
Practice Address - Street 1:2115 14TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-1760
Practice Address - Country:US
Practice Address - Phone:402-274-3709
Practice Address - Fax:402-274-4230
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE70231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice