Healthcare Provider Details

I. General information

NPI: 1023007663
Provider Name (Legal Business Name): JEFFREY J JAEGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7240 BROOKLYN BLVD SUITE 250
BROOKLYN PARK MN
55429-1274
US

IV. Provider business mailing address

7240 BROOKLYN BLVD SUITE 250
BROOKLYN PARK MN
55429-1274
US

V. Phone/Fax

Practice location:
  • Phone: 763-561-1570
  • Fax: 763-560-4928
Mailing address:
  • Phone: 763-561-1570
  • Fax: 763-560-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9949
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: