Provider Demographics
NPI:1407548191
Name:BRITTON, JORDAN DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DOUGLAS
Last Name:BRITTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 W CENTER CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7027
Mailing Address - Country:US
Mailing Address - Phone:417-595-4470
Mailing Address - Fax:
Practice Address - Street 1:729 W CENTER CIR STE 104
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7027
Practice Address - Country:US
Practice Address - Phone:417-595-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20230184501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice