MEDICARE: JORDAN A. HEBERT, DMD, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1982279295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN A. HEBERT, DMD, LLC

Provider Business Mailing Address
First Line	:	5190 MEDFORD DR # 100
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-2102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5190 MEDFORD DR # 100
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-2102
Country	:	US
Telephone Number	:	205-582-8373
Fax Number	:

Authorized Official
Title or Position	:	SPOUSE OF OWNER
Name	:	MR. JEFFRY PAUL HEBERT JR.
Credential	:
Telephone Number	:	205-229-6268

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	06/01/2021

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