MEDICARE: DR. JEFF BRECK JORDEN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0019516	TX

General Provider Information

NPI Number	:	1447283718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFF BRECK JORDEN DDS

Provider Business Mailing Address
First Line	:	6503 BUFFALO HLS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-2324
Country	:	US
Telephone Number	:	210-381-4906
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 TRUEMPER ST
Second Line	:	LACKLAND AFB
City	:	SAN ANTONIO
State	:	TX
Zip	:	78239
Country	:	US
Telephone Number	:	210-292-6227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/08/2007

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