Provider Demographics
NPI:1194344549
Name:ZEIDMAN, JORDAN (DDS)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:ZEIDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 VISCONTI ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4035
Mailing Address - Country:US
Mailing Address - Phone:631-875-0260
Mailing Address - Fax:
Practice Address - Street 1:55 OLD GATE LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3612
Practice Address - Country:US
Practice Address - Phone:203-878-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT131931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice