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General NPI Number Information
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NPI Number | 1891267456
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Entity Type | Organization
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Legal Business Name | MDC DENTAL, LLC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 135 E MARKET ST STE 116
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City | BLAIRSVILLE
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State | PA
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Zip | 15717-1369
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Country | US
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Telephone | 724-459-5310
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Fax | 724-459-5848
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Provider Business Mailing Address
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Address Line | 135 E MARKET ST STE 116
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City | BLAIRSVILLE
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State | PA
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Zip | 15717-1369
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Country | US
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Telephone | 724-459-5310
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Fax | 724-459-5848
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Authorized Official
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Title or Position | OWNER/PROVIDER DENTIST
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Name | DR. DAVID L JORDAN
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Credential | DMD
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Telephone | 724-459-5310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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