Provider Demographics
NPI:1699972943
Name:PIERCE DENTAL OFFICE PC
Entity type:Organization
Organization Name:PIERCE DENTAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:S
Authorized Official - Last Name:WRAGGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-329-6850
Mailing Address - Street 1:102 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PIERCE
Mailing Address - State:NE
Mailing Address - Zip Code:68767-1344
Mailing Address - Country:US
Mailing Address - Phone:402-329-6850
Mailing Address - Fax:402-329-4912
Practice Address - Street 1:102 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PIERCE
Practice Address - State:NE
Practice Address - Zip Code:68767-1344
Practice Address - Country:US
Practice Address - Phone:402-329-6850
Practice Address - Fax:402-329-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE61971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6197OtherDENTAL LICENSE NUMBER
NE6197OtherDENTAL LICENSE NUMBER