Healthcare Provider Details

I. General information

NPI: 1821838608
Provider Name (Legal Business Name): JORDAN CAIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 38TH AVE S
FARGO ND
58104-8507
US

IV. Provider business mailing address

229 OXBOW CIR
OXBOW ND
58047-5007
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-1368
  • Fax:
Mailing address:
  • Phone: 701-388-0485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2506
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: