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General NPI Number Information
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NPI Number | 1700362555
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Entity Type | Individual
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Provider Name | STEPHEN JAEGER DMD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 6850 UPPER BOX ELDER RD
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City | BOX ELDER
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State | MT
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Zip | 59521-9073
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Country | US
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Telephone | 406-395-4486
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Fax |
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Provider Business Mailing Address
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Address Line | 620 13TH ST W APT 5
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City | HAVRE
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State | MT
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Zip | 59501-4807
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Country | US
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Telephone | 908-619-3119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS041842
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License Number State | PA
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