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General NPI Number Information
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NPI Number | 1831508605
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES-MENTOR, MARTIN E. JORDAN, DDS, INC.
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 9114 MENTOR AVE
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City | MENTOR
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State | OH
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Zip | 44060-6404
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Country | US
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Telephone | 440-205-0616
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Fax |
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Provider Business Mailing Address
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Address Line | 9114 MENTOR AVE
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City | MENTOR
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State | OH
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Zip | 44060-6404
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Country | US
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Telephone | 440-205-0616
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. MARTIN E JORDAN
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Credential | DDS
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Telephone | 440-205-0616
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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 | 30.019465
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License Number State | OH
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