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General NPI Number Information
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NPI Number | 1841740149
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Entity Type | Organization
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Legal Business Name | JORDAN LEDGER, DDS, PC
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 10/11/2016
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Provider Practice Location Address
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Address Line | 1229 W WASHINGTON BLVD SUITE 220
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City | CHICAGO
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State | IL
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Zip | 60607-2132
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Country | US
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Telephone | 312-620-1926
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 W WASHINGTON BLVD SUITE 220
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City | CHICAGO
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State | IL
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Zip | 60607-2132
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Country | US
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Telephone | 312-620-1926
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Fax |
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Authorized Official
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Title or Position | OWNER/ORAL SURGEON
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Name | JORDAN LEDGER
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Credential | D.D.S.
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Telephone | 319-321-1394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 019028719
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License Number State | IL
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