| Ponca Family Dentistry | |
|
213 East Street Ponca NE 68770-0658 | |
| (402) 755-2291 | |
| (402) 755-2292 |
| Full Name | Ponca Family Dentistry |
|---|---|
| Speciality | Dentist |
| Location | 213 East Street, Ponca, Nebraska |
| Authorized Official Name and Position | Natalie A Fendrick (OWNER) |
| Authorized Official Contact | 4027552291 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ponca Family Dentistry 213 East Street Po Box 658 Ponca NE 68770-0658 Ph: (402) 755-2291 | Ponca Family Dentistry 213 East Street Ponca NE 68770-0658 Ph: (402) 755-2291 |
| NPI Number | 1164842191 |
|---|---|
| Provider Enumeration Date | 04/17/2014 |
| Last Update Date | 04/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164842191 | NPI | - | NPPES |
| 10025084300 | Medicaid | NE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 7008 (Nebraska) | Primary |