Provider Demographics
NPI:1861249849
Name:CLOET, WANDA (RDH)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:CLOET
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31171 ROAD V
Mailing Address - Street 2:SUTTON, NE 68979
Mailing Address - City:SUTTON
Mailing Address - State:NE
Mailing Address - Zip Code:68979
Mailing Address - Country:US
Mailing Address - Phone:402-469-0872
Mailing Address - Fax:
Practice Address - Street 1:31171 ROAD V
Practice Address - Street 2:SUTTON, NE 68979
Practice Address - City:SUTTON
Practice Address - State:NE
Practice Address - Zip Code:68979
Practice Address - Country:US
Practice Address - Phone:402-469-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE475124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist