Provider Demographics
NPI:1114247046
Name:EHLERS, JONATHAN (DDS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:EHLERS
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 1:1875 HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:WESTPHALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65085-2215
Mailing Address - Country:US
Mailing Address - Phone:573-455-2710
Mailing Address - Fax:573-455-2705
Practice Address - Street 1:1875 HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:WESTPHALIA
Practice Address - State:MO
Practice Address - Zip Code:65085-2215
Practice Address - Country:US
Practice Address - Phone:573-455-2710
Practice Address - Fax:573-455-2705
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist