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General NPI Number Information
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NPI Number | 1326867284
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Entity Type | Organization
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Legal Business Name | JORDAN BRONSTEIN DMD PLLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 2471 DELANEY AVE
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City | WILMINGTON
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State | NC
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Zip | 28403-6061
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Country | US
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Telephone | 910-762-3481
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Fax |
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Provider Business Mailing Address
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Address Line | 434 TANBRIDGE RD
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City | WILMINGTON
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State | NC
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Zip | 28405-3922
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Country | US
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Telephone | 804-855-8636
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JORDAN DAVID BRONSTEIN
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Credential | DMD
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Telephone | 804-855-8636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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