Provider Demographics
NPI:1104548692
Name:CHRISTOPHER JORDAN DDS INC.
Entity type:Organization
Organization Name:CHRISTOPHER JORDAN DDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-654-2737
Mailing Address - Street 1:39 CREEK ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7704
Mailing Address - Country:US
Mailing Address - Phone:949-654-2737
Mailing Address - Fax:949-654-2740
Practice Address - Street 1:39 CREEK ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7704
Practice Address - Country:US
Practice Address - Phone:949-654-2737
Practice Address - Fax:949-654-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty