Provider Demographics
NPI:1053803726
Name:NORDHUES, JACOB STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:STEVEN
Last Name:NORDHUES
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 1:1100 NORD ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-0844
Mailing Address - Country:US
Mailing Address - Phone:402-640-2098
Mailing Address - Fax:
Practice Address - Street 1:2104 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4640
Practice Address - Country:US
Practice Address - Phone:402-371-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice