Provider Demographics
NPI:1528268281
Name:LENTFER, JORDAN EMILEA (DMD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:EMILEA
Last Name:LENTFER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:EMILEA
Other - Last Name:SCHEFFLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:691 MURPHY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4346
Mailing Address - Country:US
Mailing Address - Phone:541-773-2625
Mailing Address - Fax:
Practice Address - Street 1:691 MURPHY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4346
Practice Address - Country:US
Practice Address - Phone:541-773-2625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89291223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279295Medicare UPIN