Provider Demographics
NPI:1124284534
Name:JORDAN, JEFFREY W (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4205 N POINT PKWY
Mailing Address - Street 2:BLDG B
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8808
Mailing Address - Country:US
Mailing Address - Phone:770-751-1240
Mailing Address - Fax:770-751-1669
Practice Address - Street 1:4205 N POINT PKWY
Practice Address - Street 2:BLDG B
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8808
Practice Address - Country:US
Practice Address - Phone:770-751-1240
Practice Address - Fax:770-751-1669
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics