NPIMap

Jordan Donald Molter, DDS

Individual provider Active NPI General Practice Dentistry · Oostburg, WI

NPI 1710666367 · NPPES record last updated Jul 12, 2023

Key facts

NPI
1710666367
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
6001181-15 (WI)
Practice address
19 N 4TH St
Oostburg, WI 53070-1250
Phone
(920) 564-2925
NPI assigned
Jul 12, 2023
Sex
Male
Sole proprietor
No

Organizations & group practices 1

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

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
6001181-15WIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Oostburg Family Dentistry, L.L.C General Practice Past
since Jul 16, 2023		 Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6001181-15 WI Yes

Addresses

Primary practice location

19 N 4TH St
Oostburg, WI 53070-1250

Mailing address

19 N 4TH St
Oostburg, WI 53070-1250
Phone (920) 564-2925

Other providers in Oostburg, WI

All providers in Oostburg, WI · General Practice Dentistry in Wisconsin

Sources for this page

Verify at the official NPI Registry.