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General NPI Number Information
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NPI Number | 1184160806
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Entity Type | Individual
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Provider Name | JORDAN MARIE BRITT D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 130 EVERGREEN RD STE 100
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City | MIDDLETOWN
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State | KY
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Zip | 40243-1480
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Country | US
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Telephone | 502-410-1710
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Fax |
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Provider Business Mailing Address
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Address Line | 125 S CRESTMOOR AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-2736
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Country | US
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Telephone | 603-568-1738
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10454
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License Number State | NC
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