Provider Demographics
NPI:1013023993
Name:JAEGER, RICK WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:WAYNE
Last Name:JAEGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 WOODTHRUSH WAY
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746
Mailing Address - Country:US
Mailing Address - Phone:916-783-8153
Mailing Address - Fax:716-783-8152
Practice Address - Street 1:8400 WOODTHRUSH WAY
Practice Address - Street 2:
Practice Address - City:GRANITE BAY
Practice Address - State:CA
Practice Address - Zip Code:95746
Practice Address - Country:US
Practice Address - Phone:916-783-8153
Practice Address - Fax:716-783-8152
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist