Provider Demographics
NPI:1083144646
Name:MCWHORTER, JORDAN SALOW (RDH)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:SALOW
Last Name:MCWHORTER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 559 BOX 6224
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96377-0063
Mailing Address - Country:US
Mailing Address - Phone:760-420-7624
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 236
Practice Address - Street 2:
Practice Address - City:YOMITAN-SON NAKAGAMI-GUN
Practice Address - State:OKINAWA
Practice Address - Zip Code:96376
Practice Address - Country:JP
Practice Address - Phone:644-411-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30639124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA011641579-02OtherTRICARE