Healthcare Provider Details

I. General information

NPI: 1609564988
Provider Name (Legal Business Name): JORDAN MICHAEL PIERCE DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 S PITTSBURG AVE
TULSA OK
74114-6133
US

IV. Provider business mailing address

1722 S CARSON AVE APT 1410
TULSA OK
74119-4695
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-8868
  • Fax:
Mailing address:
  • Phone: 580-504-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7321
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: