Provider Demographics
NPI:1366474678
Name:JORDAN, WILLIAM (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DMD, FAGD
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, FAGD
Mailing Address - Street 1:18789 SW BOONES FERRY RD
Mailing Address - Street 2:STE 4
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8412
Mailing Address - Country:US
Mailing Address - Phone:503-692-6535
Mailing Address - Fax:503-691-2831
Practice Address - Street 1:18789 SW BOONES FERRY RD
Practice Address - Street 2:STE 4
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8412
Practice Address - Country:US
Practice Address - Phone:503-692-6535
Practice Address - Fax:503-691-2831
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice