MEDICARE: JORDAN HEBERT 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	1223G0001X	General Practice Dentistry	0006519	AL

General Provider Information

NPI Number	:	1700365376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN HEBERT DMD

Provider Business Mailing Address
First Line	:	4220 7TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35222-2610
Country	:	US
Telephone Number	:	205-473-4776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 COGSWELL AVE
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-1644
Country	:	US
Telephone Number	:	205-884-2370
Fax Number	:

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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