Healthcare Provider Details

I. General information

NPI: 1427204544
Provider Name (Legal Business Name): JORDAN N BUZZELL DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TOWN CENTER PKWY STE A
SANTEE CA
92071-5801
US

IV. Provider business mailing address

110 TOWN CENTER PKWY STE A
SANTEE CA
92071-5801
US

V. Phone/Fax

Practice location:
  • Phone: 619-562-5437
  • Fax:
Mailing address:
  • Phone: 619-562-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number57219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: