MEDICARE: DR. BURT JORDAN

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	1223P0221X	Pediatric Dentistry	DN0006848	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639245137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BURT JORDAN

Provider Business Mailing Address
First Line	:	9751 E. BAY HARBOR DR.
Second Line	:	1204
City	:	MIAMI
State	:	FL
Zip	:	33154-3827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9751 E. BAY HARBOR DR.
Second Line	:	1204
City	:	MIAMI
State	:	FL
Zip	:	33154-3827
Country	:	US
Telephone Number	:	305-867-3913
Fax Number	:

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	07/08/2007

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