Provider Demographics
NPI:1306350434
Name:JORDAN, LASHETTE MARIE (DENTAL ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:LASHETTE
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:MS
Other - First Name:LASHETTE
Other - Middle Name:MARIE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 415 BOX 7753
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114-0078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GRAFENWOHR DENTAC
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09114
Practice Address - Country:US
Practice Address - Phone:254-535-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant