Provider Demographics
NPI:1104237593
Name:POND, JORDAN (DMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:POND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3787 E CULLUMBER ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4318
Mailing Address - Country:US
Mailing Address - Phone:480-294-5686
Mailing Address - Fax:
Practice Address - Street 1:9221 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-8310
Practice Address - Country:US
Practice Address - Phone:480-357-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist