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General NPI Number Information
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NPI Number | 1215260286
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Entity Type | Individual
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Provider Name | CLINT R JORDAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 130 WEST OLD HIGHWAY 2
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City | MERNA
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State | NE
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Zip | 68856
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Country | US
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Telephone | 308-643-2255
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Fax |
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Provider Business Mailing Address
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Address Line | 44080 DR 796
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City | BROKEN BOW
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State | NE
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Zip | 68822-4256
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6837
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License Number State | NE
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