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1437413119 NPI number — BENJAMIN CRAIG JORDAN D.M.D.

NPI Number: 1437413119
Health Care Provider/Practitioner: BENJAMIN CRAIG JORDAN D.M.D.

Information about “1437413119” NPI (BENJAMIN CRAIG JORDAN D.M.D.) exists in 1437413119 in HTML format HTML  |  1437413119 in plain Text format TXT  |  1437413119 in PDF (Portable Document Format) PDF  |  1437413119 in an XML format XML  formats.

NPI Number : 1437413119 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437413119",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JORDAN",
    "FirstName": "BENJAMIN",
    "MiddleName": "CRAIG",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1090",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HARTSVILLE",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29551-1090",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "843-857-0111",
    "MailingAddressFaxNumber": "843-309-8126",
    "FirstLinePracticeLocationAddress": "737 S MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOCIETY HILL",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29593-8972",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "866-815-9845",
    "PracticeLocationAddressFaxNumber": "800-882-4690",
    "EnumerationDate": "06/27/2012",
    "LastUpdateDate": "08/25/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "8089",
        "LicenseNumberStateCode": "SC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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