NPI: 1972971125 · BELLEVUE, NE 68123 · Dentist · NPI assigned 09/04/2015
| Authorized Official | RUDERSDORF, THOMAS (OWNER) |
| NPI Enumeration Date | 09/04/2015 |
| Year | Claims | Total Paid |
|---|---|---|
| 2018 | 12 | $264.00 |
| 2022 | 12 | $287.52 |
| 2023 | 14 | $239.83 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D0120 | Periodic oral evaluation - established patient | 38 | 38 | $791.35 |