Provider Demographics
NPI:1750730560
Name:HAEDT, JORDAN DANELL (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DANELL
Last Name:HAEDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2118
Mailing Address - Country:US
Mailing Address - Phone:785-742-2165
Mailing Address - Fax:
Practice Address - Street 1:514 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2118
Practice Address - Country:US
Practice Address - Phone:785-742-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist