Healthcare Provider Details

I. General information

NPI: 1710995774
Provider Name (Legal Business Name): JANET LORRAINE JORDAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12010 S WARNER ELLIOT LP STE #2
PHOENIX AZ
85044
US

IV. Provider business mailing address

12010 S WARNER ELLIOT LP STE #2
PHOENIX AZ
85044
US

V. Phone/Fax

Practice location:
  • Phone: 480-598-3659
  • Fax: 480-598-9102
Mailing address:
  • Phone: 480-598-3659
  • Fax: 480-598-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD4271
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: