Provider Demographics
NPI:1083417471
Name:VICE, JORDAN DONALD (DMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:DONALD
Last Name:VICE
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 1:5923 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3207
Mailing Address - Country:US
Mailing Address - Phone:336-632-0744
Mailing Address - Fax:
Practice Address - Street 1:5923 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3207
Practice Address - Country:US
Practice Address - Phone:336-632-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program