Active NPI
Roger Trent Minneman, D.D.S.
- Dentist
- Wauneta, NE
National Provider Identifier
1245270941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4612
- Practice address
- 639 W Legion St
Wauneta, NE 69045-0104 - Phone
- (308) 394-5188
- Fax
- (308) 394-5189
- NPI assigned
- Jun 8, 2006
- Last updated
- Dec 5, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4612 | NE | Primary |
Addresses
Primary practice location
639 W Legion St
Wauneta, NE 69045-0104
Mailing address
PO Box 104
Wauneta, NE 69045-0104
Phone (308) 394-5188
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4612 | NE | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228435200000",
"number": "1245270941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 104",
"city": "WAUNETA",
"state": "NE",
"postal_code": "690450104",
"telephone_number": "308-394-5188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "639 W LEGION ST",
"city": "WAUNETA",
"state": "NE",
"postal_code": "690450104",
"telephone_number": "308-394-5188",
"fax_number": "308-394-5189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MINNEMAN",
"first_name": "ROGER",
"middle_name": "TRENT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-08",
"last_updated": "2008-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NE",
"license": "4612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wauneta, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.