Provider Demographics
NPI:1033266291
Name:JORDAN, CHRISTOPHER N (DDS, MSD, PC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:N
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DDS, MSD, PC
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 1727
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008-1727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11711 W BURLEIGH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3196
Practice Address - Country:US
Practice Address - Phone:414-771-2345
Practice Address - Fax:414-777-3839
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210019861223X0400X
WI10027041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics