Provider Demographics
NPI:1982087193
Name:JANDRAIN, BRIDGETT AMBER (RDH)
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:AMBER
Last Name:JANDRAIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4022 COUNTY ROAD V
Mailing Address - Street 2:
Mailing Address - City:LUXEMBURG
Mailing Address - State:WI
Mailing Address - Zip Code:54217-7858
Mailing Address - Country:US
Mailing Address - Phone:920-655-3532
Mailing Address - Fax:
Practice Address - Street 1:W286N991 SHEPHERDS WAY
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-9493
Practice Address - Country:US
Practice Address - Phone:414-651-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6494-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist