Jordan Leroy Ingersoll, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

7995 Issued in NE

Practice address

5323 N 134TH Ave
Omaha, NE 68164-6302

Phone

(402) 492-9303

NPI assigned

Jun 24, 2022

Last updated

Sep 15, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jill E. Hild, DDS

  • General Practice Dentistry
  • Omaha, NE
  • NPI 1801341219
  NPD (past)
• Complete Family Dentistry on Broadway

  dba complete family dentistry

  • General Practice Dentistry
  • Waukesha, WI
  • NPI 1174524425
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726358400000",
    "number": "1710619226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5323 N 134TH AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681646302",
            "telephone_number": "402-492-9303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5323 N 134TH AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681646302",
            "telephone_number": "402-492-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGERSOLL",
        "first_name": "JORDAN",
        "middle_name": "LEROY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-24",
        "last_updated": "2024-09-15",
        "certification_date": "2024-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NE",
            "license": "7995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Infinity Home Health Care
• Diane Ingabire
• Andrew James Ingemansen, M.D.
• Margaret Wollschlager Ingemansen, M.D.
• Holly Lynn Ingersoll, DDS
• Vanessa Ingersoll
• Kelly Inglisa, MA
• Amanda Marie Ingram
• Benjamin Ingram
• Christine Ingram, LIMHP

• Dentist in Omaha, NE
• Providers in Omaha, NE by specialty
• Dentist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.