Provider Demographics
NPI:1336209287
Name:JAKE M JUHL DDS
Entity Type:Organization
Organization Name:JAKE M JUHL DDS
Other - Org Name:JASON M JUHL, DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:JUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-260-2183
Mailing Address - Street 1:2045 E LABRADOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-3996
Mailing Address - Country:US
Mailing Address - Phone:620-260-2183
Mailing Address - Fax:620-260-2188
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty