Provider Demographics
NPI:1215220876
Name:JORDAN H. COUNCILL DDS PA
Entity Type:Organization
Organization Name:JORDAN H. COUNCILL DDS PA
Other - Org Name:DOGWOOD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:COUNCILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-398-4910
Mailing Address - Street 1:10 BROOK ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-5500
Mailing Address - Country:US
Mailing Address - Phone:828-398-4910
Mailing Address - Fax:877-828-5936
Practice Address - Street 1:10 BROOK ST
Practice Address - Street 2:SUITE 215
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-5500
Practice Address - Country:US
Practice Address - Phone:828-398-4910
Practice Address - Fax:877-828-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty