Provider Demographics
NPI:1093027021
Name:JORDAN, ROBERT SAUNDERS III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAUNDERS
Last Name:JORDAN
Suffix:III
Gender:M
Credentials:DDS
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 488
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-0488
Mailing Address - Country:US
Mailing Address - Phone:276-638-3712
Mailing Address - Fax:
Practice Address - Street 1:295 COMMONWEALTH BLVD W
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1820
Practice Address - Country:US
Practice Address - Phone:276-638-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010026741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice