Individual
DR. JORDAN DIETRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
400 S TOWNLINE RD, WAUTOMA, WI 54982-6922
(920) 787-5514
Mailing address
400 S TOWNLINE RD, WAUTOMA, WI 54982-6922
(920) 787-5517
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6001224-15
WI
Other
Enumeration date
06/26/2023
Last updated
10/02/2025
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