MEDICARE: DR. MATTHEW S JORDAN 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
1	1223G0001X	General Practice Dentistry	21830	OH

General Provider Information

NPI Number	:	1942202189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW S JORDAN DDS

Provider Business Mailing Address
First Line	:	26 E MAIN ST
Second Line	:
City	:	LEXINGTON
State	:	OH
Zip	:	44904-1223
Country	:	US
Telephone Number	:	419-884-3411
Fax Number	:	419-884-0656

Provider Business Practice Location Address
First Line	:	26 E MAIN ST
Second Line	:
City	:	LEXINGTON
State	:	OH
Zip	:	44904-1223
Country	:	US
Telephone Number	:	419-884-3411
Fax Number	:	419-884-0656

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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