Provider Demographics
NPI:1710666367
Name:MOLTER, JORDAN DONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DONALD
Last Name:MOLTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OOSTBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53070-1250
Mailing Address - Country:US
Mailing Address - Phone:920-564-2925
Mailing Address - Fax:
Practice Address - Street 1:19 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OOSTBURG
Practice Address - State:WI
Practice Address - Zip Code:53070-1250
Practice Address - Country:US
Practice Address - Phone:920-564-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001181-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice