Provider Demographics
NPI:1306931076
Name:JORDAN, SHERRY R (DMD)
Entity type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:R
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1735 BUFORD HWY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1266
Mailing Address - Country:US
Mailing Address - Phone:770-888-6262
Mailing Address - Fax:678-208-2300
Practice Address - Street 1:1735 BUFORD HWY
Practice Address - Street 2:SUITE 135
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-1266
Practice Address - Country:US
Practice Address - Phone:770-888-6262
Practice Address - Fax:678-208-2300
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA114731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice