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General NPI Number Information
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NPI Number | 1114047073
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Entity Type | Organization
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Legal Business Name | JOHN R JORDAN DMD PL
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Dates
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Enumeration Date | 04/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1515 N FLAGLER DR STE #360
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3428
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Country | US
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Telephone | 561-659-1688
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Fax | 561-659-5658
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Provider Business Mailing Address
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Address Line | 1515 N FLAGLER DR STE #360
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3428
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Country | US
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Telephone | 561-659-1688
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Fax | 561-659-5658
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN R JORDAN
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Credential | DMD
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Telephone | 561-659-1688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6849
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License Number State | FL
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