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General NPI Number Information
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NPI Number | 1245405877
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Entity Type | Organization
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Legal Business Name | JORDAN DENTAL GROUP INC
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 6120 PASEO DEL NORTE K1
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City | CARLSBAD
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State | CA
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Zip | 92011-1150
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Country | US
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Telephone | 760-438-0948
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Fax | 760-438-7821
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Provider Business Mailing Address
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Address Line | PO BOX 130939
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City | CARLSBAD
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State | CA
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Zip | 92013-0939
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Country | US
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Telephone | 760-438-0948
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Fax | 760-438-7821
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | MELISSA SUE NELSON
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Credential | R.D.A.
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Telephone | 760-438-0948
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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 | 28010
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License Number State | CA
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