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General NPI Number Information
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NPI Number | 1518883461
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Entity Type | Individual
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Provider Name | JORDAN DEL MORAL DDS
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Gender | Male
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Dates
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Enumeration Date | 06/25/2026
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Last Update Date | 06/25/2026
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Provider Practice Location Address
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Address Line | 601 SE 117TH AVE STE 100
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City | VANCOUVER
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State | WA
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Zip | 98683-5297
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Country | US
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Telephone | 360-260-4172
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Fax |
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Provider Business Mailing Address
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Address Line | 1543 NW 40TH AVE
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City | CAMAS
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State | WA
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Zip | 98607-8617
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Country | US
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Telephone | 360-977-2621
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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 | DENT.DE.70137906
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License Number State | WA
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