Provider Demographics
NPI:1457403271
Name:JAEGER, THOMAS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:JAEGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ERIK
Other - Middle Name:R
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1717 LINCOLN WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2556
Mailing Address - Country:US
Mailing Address - Phone:208-667-3341
Mailing Address - Fax:208-664-8973
Practice Address - Street 1:1717 LINCOLN WAY STE 203
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2556
Practice Address - Country:US
Practice Address - Phone:208-667-3341
Practice Address - Fax:208-664-8973
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID66D18521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics