Provider Demographics
NPI:1386634350
Name:JORDAN, MARTIN EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:EUGENE
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 YOAKUM PKWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4060
Mailing Address - Country:US
Mailing Address - Phone:216-210-8200
Mailing Address - Fax:
Practice Address - Street 1:300 YOAKUM PKWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4060
Practice Address - Country:US
Practice Address - Phone:216-210-8200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist