Provider Demographics
NPI:1760472518
Name:JUHL, JAKE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAKE
Middle Name:M
Last Name:JUHL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:M
Other - Last Name:JUHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:506 E THORPE ST
Mailing Address - Street 2:
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-9625
Mailing Address - Country:US
Mailing Address - Phone:620-355-6500
Mailing Address - Fax:620-355-8007
Practice Address - Street 1:2045 E LABRADOR BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-3996
Practice Address - Country:US
Practice Address - Phone:620-260-2183
Practice Address - Fax:620-260-2188
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS71291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110892OtherBILLING PROVIDER #