Provider Demographics
NPI:1568699270
Name:KORTJE, JANA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:M
Last Name:KORTJE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 W 67TH TER
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:KS
Mailing Address - Zip Code:66208-1849
Mailing Address - Country:US
Mailing Address - Phone:402-841-9387
Mailing Address - Fax:
Practice Address - Street 1:4746 BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1315
Practice Address - Country:US
Practice Address - Phone:816-531-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-20
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60786122300000X
NE68431223G0001X
MO2011010552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice