Provider Demographics
NPI:1952475162
Name:TREDER, JEAN ESTELLE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ESTELLE
Last Name:TREDER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 10TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2372
Mailing Address - Country:US
Mailing Address - Phone:319-339-1754
Mailing Address - Fax:
Practice Address - Street 1:414 10TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2372
Practice Address - Country:US
Practice Address - Phone:319-339-1754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA071891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1087452Medicaid