Provider Demographics
NPI:1316144751
Name:TOPP, JORDANA BETH (DMD)
Entity type:Individual
Prefix:
First Name:JORDANA
Middle Name:BETH
Last Name:TOPP
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 SADDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1552
Mailing Address - Country:US
Mailing Address - Phone:516-374-3399
Mailing Address - Fax:
Practice Address - Street 1:290 CENTRAL AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-8507
Practice Address - Country:US
Practice Address - Phone:516-225-8663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist