Provider Demographics
NPI:1750410155
Name:JAEGER, JOHN ELWOOD (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELWOOD
Last Name:JAEGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EMINENCE TER
Mailing Address - Street 2:
Mailing Address - City:EMINENCE
Mailing Address - State:KY
Mailing Address - Zip Code:40019-1145
Mailing Address - Country:US
Mailing Address - Phone:502-845-5338
Mailing Address - Fax:
Practice Address - Street 1:105 EMINENCE TER
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:KY
Practice Address - Zip Code:40019-1145
Practice Address - Country:US
Practice Address - Phone:502-845-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice