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NPI Code Detail

MEDICARE: DR. JORDAN M JOB DDS

MEDICARE: DR. JORDAN M JOB DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry30-024000OH

General Provider Information

NPI Number : 1114367075
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORDAN M JOB DDS
Provider Business Mailing Address
First Line : 1300 W 9TH ST APT 706
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-1037
Country : US
Telephone Number : 330-807-6672
Fax Number :
Provider Business Practice Location Address
First Line : 6929 W 130TH ST STE 600
Second Line :
City : PARMA HEIGHTS
State : OH
Zip : 44130-7878
Country : US
Telephone Number : 440-888-5855
Fax Number : 440-888-9924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2013
Last Update Date : 01/09/2015

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