Provider Demographics
NPI:1538150412
Name:ANDREW P STADLER DDS PC
Entity type:Organization
Organization Name:ANDREW P STADLER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:STADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:402-564-4093
Mailing Address - Street 1:PO BOX 1667
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68602-1667
Mailing Address - Country:US
Mailing Address - Phone:402-564-4093
Mailing Address - Fax:402-564-4086
Practice Address - Street 1:2457 33RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1309
Practice Address - Country:US
Practice Address - Phone:402-564-4093
Practice Address - Fax:402-564-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1448295OtherUNITED CONCORDIA
NE6248OtherBCBS
AL76002976OtherBCBS
MAZ87045OtherBCBS
AL76002976OtherBCBS