Healthcare Provider Details

I. General information

NPI: 1083144646
Provider Name (Legal Business Name): JORDAN SALOW MCWHORTER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 236
YOMITAN-SON NAKAGAMI-GUN OKINAWA
96376
JP

IV. Provider business mailing address

PSC 559 BOX 6224
FPO AP
96377-0063
US

V. Phone/Fax

Practice location:
  • Phone: 644-411-0000
  • Fax:
Mailing address:
  • Phone: 760-420-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number30639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: