Provider Demographics
NPI:1497269963
Name:JORDAN D HAEDT DDS LLC
Entity Type:Organization
Organization Name:JORDAN D HAEDT DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:DANELL
Authorized Official - Last Name:HAEDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-742-2165
Mailing Address - Street 1:514 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2118
Mailing Address - Country:US
Mailing Address - Phone:785-742-2165
Mailing Address - Fax:
Practice Address - Street 1:514 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2118
Practice Address - Country:US
Practice Address - Phone:785-742-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS611891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty