Provider Demographics
NPI:1316556053
Name:ALE, JERDIE MANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERDIE
Middle Name:MANUEL
Last Name:ALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JERDIE
Other - Middle Name:MANUEL
Other - Last Name:ALE-SALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 NORTH RIVER DRIVE
Mailing Address - Street 2:UNIT 414
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403
Mailing Address - Country:US
Mailing Address - Phone:678-467-4733
Mailing Address - Fax:
Practice Address - Street 1:2606 STEWART AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-842-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002383-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice