Provider Demographics
NPI:1326867284
Name:JORDAN BRONSTEIN DMD PLLC
Entity type:Organization
Organization Name:JORDAN BRONSTEIN DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRONSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:804-855-8636
Mailing Address - Street 1:434 TANBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3922
Mailing Address - Country:US
Mailing Address - Phone:804-855-8636
Mailing Address - Fax:
Practice Address - Street 1:2471 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6061
Practice Address - Country:US
Practice Address - Phone:910-762-3481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental