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General NPI Number Information
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NPI Number | 1184827545
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Entity Type | Individual
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Provider Name | SHERRILL LEIGH JORDAN DDS
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Gender | Female
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 4314 WYO RD
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City | YADKINVILLE
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State | NC
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Zip | 27055-8728
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Country | US
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Telephone | 336-463-2073
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Fax |
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Provider Business Mailing Address
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Address Line | 4608 LOGAN CREEK RD
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City | EAST BEND
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State | NC
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Zip | 27018-8618
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Country | US
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Telephone | 919-260-7344
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 8383
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License Number State | NC
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