Provider Demographics
NPI:1306466172
Name:JORDAN RICHERT DMD, PC
Entity type:Organization
Organization Name:JORDAN RICHERT DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-358-8489
Mailing Address - Street 1:311 OAK ST APT 740
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4627
Mailing Address - Country:US
Mailing Address - Phone:480-358-8489
Mailing Address - Fax:
Practice Address - Street 1:895 MORAGA RD STE 6
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-5039
Practice Address - Country:US
Practice Address - Phone:925-283-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty