Provider Demographics
NPI:1003175837
Name:WACHTER, JANE LEA (DDS)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:LEA
Last Name:WACHTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:LEA
Other - Last Name:TRAMBLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:102 W SENECA ST
Mailing Address - Street 2:PO BOX 68
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869-1363
Mailing Address - Country:US
Mailing Address - Phone:308-452-3523
Mailing Address - Fax:308-452-3846
Practice Address - Street 1:102 W SENECA ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:NE
Practice Address - Zip Code:68869-1363
Practice Address - Country:US
Practice Address - Phone:308-452-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08906122300000X
NE7198122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist