Provider Demographics
NPI:1013534189
Name:STRIEGEL, JORDAN TYLER
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:TYLER
Last Name:STRIEGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 GRANT LINE CTR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2103
Mailing Address - Country:US
Mailing Address - Phone:812-949-7677
Mailing Address - Fax:
Practice Address - Street 1:302 GRANT LINE CTR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2103
Practice Address - Country:US
Practice Address - Phone:812-949-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013445A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice