Provider Demographics
NPI:1194032920
Name:WATERHOUSE, JEFFREY DAVID (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
Last Name:WATERHOUSE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-2943
Mailing Address - Country:US
Mailing Address - Phone:785-899-3025
Mailing Address - Fax:785-899-3025
Practice Address - Street 1:1014 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-2943
Practice Address - Country:US
Practice Address - Phone:785-899-3025
Practice Address - Fax:785-899-3025
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics