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General NPI Number Information
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NPI Number | 1669897286
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Entity Type | Individual
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Provider Name | DR. SARAH JORDAN
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Gender | Female
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 701 WASHINGTON ST
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City | NEWTONVILLE
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State | MA
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Zip | 02458-1386
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Country | US
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Telephone | 212-410-6969
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Fax |
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Provider Business Mailing Address
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Address Line | 308 CHELSEA ST UNIT 3
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City | BOSTON
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State | MA
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Zip | 02128-1745
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Country | US
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Telephone | 603-682-3086
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1857553
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 057961
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1857553
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License Number State | MA
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