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General NPI Number Information
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NPI Number | 1720180813
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Entity Type | Individual
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Provider Name | JASON BRENT JORDAN DMD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 279 5TH AVE
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City | ASHVILLE
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State | AL
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Zip | 35953
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Country | US
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Telephone | 205-594-5044
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Fax | 205-594-5044
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Provider Business Mailing Address
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Address Line | PO BOX 129
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City | ASHVILLE
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State | AL
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Zip | 35953
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Country | US
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Telephone | 205-594-5044
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Fax | 205-594-5388
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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 | 5192
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License Number State | AL
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