Provider Demographics
NPI:1285735894
Name:JAEGER, FREDERICK JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOHN
Last Name:JAEGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4414 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4961
Mailing Address - Country:US
Mailing Address - Phone:608-231-2424
Mailing Address - Fax:608-231-9983
Practice Address - Street 1:4414 REGENT ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4961
Practice Address - Country:US
Practice Address - Phone:608-231-2424
Practice Address - Fax:608-231-9983
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33437300Medicaid
WI134703OtherUNITED CONCORDIA