Provider Demographics
NPI:1174656938
Name:OREAR, JEFFREY W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:OREAR
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 1:110 N OGDEN RD
Mailing Address - Street 2:
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1730
Mailing Address - Country:US
Mailing Address - Phone:715-582-4571
Mailing Address - Fax:715-582-4986
Practice Address - Street 1:110 N OGDEN RD
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1730
Practice Address - Country:US
Practice Address - Phone:715-582-4571
Practice Address - Fax:715-582-4986
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0003061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33448700Medicaid