Provider Demographics
NPI:1184827545
Name:JORDAN, SHERRILL LEIGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERRILL
Middle Name:LEIGH
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 LOGAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EAST BEND
Mailing Address - State:NC
Mailing Address - Zip Code:27018-8618
Mailing Address - Country:US
Mailing Address - Phone:919-260-7344
Mailing Address - Fax:
Practice Address - Street 1:4314 WYO RD
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8728
Practice Address - Country:US
Practice Address - Phone:336-463-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist