Provider Demographics
NPI:1114367075
Name:JOB, JORDAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:M
Last Name:JOB
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 1:1300 W 9TH ST APT 706
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1037
Mailing Address - Country:US
Mailing Address - Phone:330-807-6672
Mailing Address - Fax:
Practice Address - Street 1:6929 W 130TH ST STE 600
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7878
Practice Address - Country:US
Practice Address - Phone:440-888-5855
Practice Address - Fax:440-888-9924
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0240001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice