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DR. JORDAN DIETRICH DDS
NPI 1902582604
Dentist - General Practice in Wautoma, WI

Active since June 26, 2023
400 S TOWNLINE RD, WAUTOMA, WI 54982(920) 787-5514 Get Directions Write a Review

NPPES record last updated: October 2, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Jordan Dietrich Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JORDAN DIETRICH DDS (NPI 1902582604) is an individual general practice provider in Wautoma, Wisconsin, licensed in Wisconsin (6001224-15) and active in the NPI registry since June 2023.

NPPES Registry Identity

NPI1902582604
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. JORDAN DIETRICHCredential: DDS
Location Address400 S TOWNLINE RDWautoma, WI 54982-6922
Mailing Address400 S Townline RdWautoma, WI 54982-6922 · (920) 787-5517
Phone(920) 787-5514
Sole ProprietorNo
Enumeration DateJune 26, 2023
Last NPPES UpdateOctober 2, 2025
NPPES CertifiedOctober 2, 2025
✔ NPI 1902582604 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in WI · 6001224-15
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
400 S TOWNLINE RD, Wautoma, WI 54982
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KAYLA MEILICK RDH
Dental Hygienist
400 S TOWNLINE RD
WAUTOMA, WI 54982
Waushara County (920) 787-5514
JANET KRIEDERMANN RECORE RDH
Dental Hygienist
400 S TOWNLINE RD
WAUTOMA, WI 54982
Waushara County (920) 787-5514
HOLLY L KRIZAN RDH
Dental Hygienist
400 S TOWNLINE RD
WAUTOMA, WI 54982
Waushara County (920) 787-5514
AMY SCHOENOFF APNP
Nurse Practitioner (Psychiatric/Mental Health)
400 S TOWNLINE RD
WAUTOMA, WI 54982
Waushara County (920) 787-5514
LA CLINICA DE LOS CAMPESINOS, INC
Pharmacy
400 S TOWNLINE RD
WAUTOMA, WI 54982
Waushara County (920) 647-8984
DR. JOAN L. FOX DDS
Dentist (General Practice)
400 S TOWNLINE RD
WAUTOMA, WI 54982
Waushara County (920) 787-5514
MRS. ERIKA RENAE ANNA RDN, CD
Dietitian, Registered
400 S TOWNLINE RD
WAUTOMA, WI 54982
Waushara County (920) 787-5514
JOSEPH W CARON MD
Family Medicine
400 S TOWNLINE RD
WAUTOMA, WI 54982
Waushara County (800) 942-5330

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jordan Dietrich's NPI number?

The NPI number for Jordan Dietrich is 1902582604. It was assigned to this individual provider in the NPPES registry on June 26, 2023.

Where is Jordan Dietrich located?

Jordan Dietrich practices at 400 S Townline Rd, Wautoma, WI 54982. The listed phone number is (920) 787-5514.

What is Jordan Dietrich's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

What insurance does Jordan Dietrich accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 9 other insurers list Jordan Dietrich as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jordan Dietrich was last updated on October 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.