Provider Demographics
NPI:1386809333
Name:JORDAN, SHAWN FRANCIS (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:FRANCIS
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 GRAND ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6603
Mailing Address - Country:US
Mailing Address - Phone:716-695-3636
Mailing Address - Fax:716-264-4160
Practice Address - Street 1:125 GRAND ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6603
Practice Address - Country:US
Practice Address - Phone:716-695-3636
Practice Address - Fax:716-264-4160
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0539041223E0200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05227936Medicaid