Provider Demographics
NPI:1073033171
Name:JORDAN, KIRSTEN OCHALA (DMD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:OCHALA
Last Name:JORDAN
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 E 44TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2327
Mailing Address - Country:US
Mailing Address - Phone:770-653-5680
Mailing Address - Fax:
Practice Address - Street 1:400 JOHNNY MERCER BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-2166
Practice Address - Country:US
Practice Address - Phone:912-897-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist