Provider Demographics
NPI:1427858232
Name:JORDAN, ETHAN E (DMD)
Entity type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:E
Last Name:JORDAN
Suffix:
Gender:
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:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:FRYEBURG
Mailing Address - State:ME
Mailing Address - Zip Code:04037-0042
Mailing Address - Country:US
Mailing Address - Phone:207-890-1349
Mailing Address - Fax:
Practice Address - Street 1:1100 FLORIDA AVENUE
Practice Address - Street 2:BOX 18, ROOM 5321
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-2799
Practice Address - Country:US
Practice Address - Phone:504-941-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program