Provider Demographics
NPI:1437904851
Name:FEUCHTENBERGER, JORDAN (DDS - STUDENT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:FEUCHTENBERGER
Suffix:
Gender:F
Credentials:DDS - STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:IDA GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:51445-1713
Mailing Address - Country:US
Mailing Address - Phone:712-371-2887
Mailing Address - Fax:
Practice Address - Street 1:CREIGHTON UNIVERSITY SCHOOL OF DENTISTRY
Practice Address - Street 2:2109 CUMING STREET
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102
Practice Address - Country:US
Practice Address - Phone:402-280-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program