Provider Demographics
NPI:1881719243
Name:HEDLUND, LOUIS M (DDS)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
Last Name:HEDLUND
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 1:6901 S 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3663
Mailing Address - Country:US
Mailing Address - Phone:402-421-7080
Mailing Address - Fax:402-486-1317
Practice Address - Street 1:4940 NORMAL BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6316
Practice Address - Country:US
Practice Address - Phone:402-486-1200
Practice Address - Fax:402-486-1317
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
727208OtherUNITED CONCORDIA PROVIDER
NE47078869213Medicaid
470788692241OtherDELTA PROVIDER NUMBER
5783OtherBCBS PROVIDER NUMBER