Provider Demographics
NPI:1396858221
Name:JOURDAN, ROBERT MILTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MILTON
Last Name:JOURDAN
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 1:22W301 AHLSTRAND RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-7150
Mailing Address - Country:US
Mailing Address - Phone:630-858-7976
Mailing Address - Fax:630-545-9155
Practice Address - Street 1:586 DUANE ST STE 301
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4639
Practice Address - Country:US
Practice Address - Phone:630-469-0296
Practice Address - Fax:630-545-9155
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice