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General NPI Number Information
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NPI Number | 1639429442
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Entity Type | Organization
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Legal Business Name | JORDAN HILLIS D.D.S. PA
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 96 WEBSTER DR
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City | ASHDOWN
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State | AR
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Zip | 71822-9103
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Country | US
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Telephone | 870-898-8888
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Fax | 870-898-4650
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Provider Business Mailing Address
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Address Line | 96 WEBSTER DR
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City | ASHDOWN
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State | AR
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Zip | 71822-9103
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Country | US
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Telephone | 870-898-8888
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Fax | 870-898-4650
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Authorized Official
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Title or Position | DENTIST
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Name | MR. JORDAN T HILLIS
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Credential | D.D.S.
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Telephone | 870-898-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3665
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License Number State | AR
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