Provider Demographics
NPI:1730972738
Name:KRIVANEK, JORDAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:KRIVANEK
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 1:4717 165TH ST N
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9521
Mailing Address - Country:US
Mailing Address - Phone:651-387-6084
Mailing Address - Fax:
Practice Address - Street 1:2409 HILS CT
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-1141
Practice Address - Country:US
Practice Address - Phone:715-309-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001818-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist