Healthcare Provider Details

I. General information

NPI: 1316873680
Provider Name (Legal Business Name): JORDAN CHOPRA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 N HWY 97 STE 120
BEND OR
97703-7571
US

IV. Provider business mailing address

936 SE MALIAH AVE
MADRAS OR
97741-2059
US

V. Phone/Fax

Practice location:
  • Phone: 541-640-4584
  • Fax:
Mailing address:
  • Phone: 541-420-6041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: