Provider Demographics
NPI:1417248261
Name:LEDGER, JORDAN RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:RAY
Last Name:LEDGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1229 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2132
Mailing Address - Country:US
Mailing Address - Phone:312-620-1926
Mailing Address - Fax:312-610-5638
Practice Address - Street 1:1229 W WASHINGTON BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2132
Practice Address - Country:US
Practice Address - Phone:312-620-1926
Practice Address - Fax:312-610-5638
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0287191223S0112X
IA088561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery