MEDICARE: JORDAN LEROY TINGEY DMD

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
1	122300000X	Dentist	7342	OK
2	122300000X	Dentist	DE61314568	WA

General Provider Information

NPI Number	:	1578188314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN LEROY TINGEY DMD

Provider Business Mailing Address
First Line	:	400 RIVERWALK TER STE 250
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-5619
Country	:	US
Telephone Number	:	918-998-0996
Fax Number	:

Provider Business Practice Location Address
First Line	:	1512 SW 89TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6307
Country	:	US
Telephone Number	:	405-691-3399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	09/26/2024

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