Provider Demographics
NPI:1033759873
Name:JONATHAN R EHLERS DDS PC
Entity Type:Organization
Organization Name:JONATHAN R EHLERS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:EHLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:660-827-2405
Mailing Address - Street 1:991 WINCHESTER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2553
Mailing Address - Country:US
Mailing Address - Phone:660-827-2405
Mailing Address - Fax:660-951-1160
Practice Address - Street 1:991 WINCHESTER DR STE 1
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2553
Practice Address - Country:US
Practice Address - Phone:660-827-2405
Practice Address - Fax:660-951-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty