Healthcare Provider Details

I. General information

NPI: 1497537534
Provider Name (Legal Business Name): JORDAN PIERCE DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 S PITTSBURG AVE
TULSA OK
74114-6133
US

IV. Provider business mailing address

2902 S PITTSBURG AVE
TULSA OK
74114-6133
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-8868
  • Fax:
Mailing address:
  • Phone: 918-748-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: JORDAN MICHAEL PIERCE
Title or Position: OWNER
Credential: DDS, MS
Phone: 918-748-8868