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General NPI Number Information
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NPI Number | 1790903771
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Entity Type | Individual
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Provider Name | RALPH JORDAN DDS
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1451 BELLE HAVEN RD SUITE 430
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City | ALEXANDRIA
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State | VA
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Zip | 22307-1201
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Country | US
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Telephone | 703-765-7777
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Fax | 703-765-7794
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Provider Business Mailing Address
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Address Line | 11312 SUNDIAL CT.
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City | RESTON
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State | VA
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Zip | 20194
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Country | US
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Telephone | 703-435-4747
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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 | 4110
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License Number State | VA
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