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General NPI Number Information
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NPI Number | 1942578869
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Entity Type | Individual
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Provider Name | ANDRE JORDAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 4315 LOCKWOOD DR 3
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City | HOUSTON
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State | TX
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Zip | 77026-4117
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Country | US
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Telephone | 713-291-8228
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Fax |
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Provider Business Mailing Address
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Address Line | 3314 S MACGREGOR WAY
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City | HOUSTON
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State | TX
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Zip | 77021-1107
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Country | US
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Telephone | 713-748-3861
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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 | 27587
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 27587
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License Number State | TX
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