Provider Demographics
NPI:1205859808
Name:JORDAN, KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:
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 1:677 BARATARIA BLVD
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-1835
Mailing Address - Country:US
Mailing Address - Phone:504-341-3535
Mailing Address - Fax:504-340-7081
Practice Address - Street 1:677 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-1835
Practice Address - Country:US
Practice Address - Phone:504-341-3535
Practice Address - Fax:504-340-7081
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF4043OtherBLUE CROSS
LA689169OtherUNITED CONCORDIA