Provider Demographics
NPI:1982623237
Name:JORDAN, SCOTT M (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:285 N EL CAMINO REAL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5383
Mailing Address - Country:US
Mailing Address - Phone:760-753-3533
Mailing Address - Fax:760-753-9327
Practice Address - Street 1:285 N EL CAMINO REAL
Practice Address - Street 2:SUITE 210
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5383
Practice Address - Country:US
Practice Address - Phone:760-753-3533
Practice Address - Fax:760-753-9327
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice