=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144913906
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOURDAN KIDD DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2023
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10780 WASHINGTON ST
-----------------------------------------------------
City | NORTHGLENN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80233-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-452-6630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5375 S OTIS CT
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80123-0676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DEN.00205617
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------