Provider Demographics
NPI:1063515500
Name:KUMPF, REX DAVID (DDS)
Entity type:Individual
Prefix:
First Name:REX
Middle Name:DAVID
Last Name:KUMPF
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:PO BOX 1498
Mailing Address - Street 2:2526 17TH STREET
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-1498
Mailing Address - Country:US
Mailing Address - Phone:402-564-4408
Mailing Address - Fax:402-564-4409
Practice Address - Street 1:2526 17TH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68602
Practice Address - Country:US
Practice Address - Phone:402-564-4408
Practice Address - Fax:402-564-4409
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-080645100Medicaid