Provider Demographics
NPI:1003437302
Name:JERDE ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:JERDE ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JERDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-440-8082
Mailing Address - Street 1:521 SW HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1409
Mailing Address - Country:US
Mailing Address - Phone:406-728-0397
Mailing Address - Fax:
Practice Address - Street 1:521 SW HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1409
Practice Address - Country:US
Practice Address - Phone:406-728-0397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty