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General NPI Number Information
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NPI Number | 1427431261
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Entity Type | Individual
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Provider Name | JESSICA JORDAN DDS
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Gender | Female
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 1350 CONCOURSE AVE STE 446
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City | MEMPHIS
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State | TN
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Zip | 38104-2026
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Country | US
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Telephone | 901-881-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 CONCOURSE AVE STE 446
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City | MEMPHIS
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State | TN
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Zip | 38104-2026
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Country | US
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Telephone | 901-881-1234
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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 | 4056
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4338-22
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10410
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License Number State | TN
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