Provider Demographics
NPI:1205417375
Name:PACHTER, JORDANA LAUREN
Entity Type:Individual
Prefix:
First Name:JORDANA
Middle Name:LAUREN
Last Name:PACHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 W OAKLAND PARK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1245
Mailing Address - Country:US
Mailing Address - Phone:954-890-2526
Mailing Address - Fax:
Practice Address - Street 1:5950 W OAKLAND PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1245
Practice Address - Country:US
Practice Address - Phone:954-890-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN265871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program