Provider Demographics
NPI:1548285919
Name:KRUEGER, RICHARD THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:THOMAS
Last Name:KRUEGER
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 1:246 VINCENT AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHAPPELL
Mailing Address - State:NE
Mailing Address - Zip Code:69129-0468
Mailing Address - Country:US
Mailing Address - Phone:308-874-2910
Mailing Address - Fax:308-874-2459
Practice Address - Street 1:246 VINCENT AVENUE
Practice Address - Street 2:
Practice Address - City:CHAPPELL
Practice Address - State:NE
Practice Address - Zip Code:69129-0468
Practice Address - Country:US
Practice Address - Phone:308-874-2910
Practice Address - Fax:308-874-2459
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470658514-13Medicaid