Provider Demographics
NPI:1093939654
Name:JORDAN, JEFFREY LAMONT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LAMONT
Last Name:JORDAN
Suffix:
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 1:5963 CALAIS COURT
Mailing Address - Street 2:5963 CALAIS COURT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220
Mailing Address - Country:US
Mailing Address - Phone:317-254-5601
Mailing Address - Fax:
Practice Address - Street 1:5963 CALAIS COURT
Practice Address - Street 2:6008 EAST 46TH ST.
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220
Practice Address - Country:US
Practice Address - Phone:317-254-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist