Provider Demographics
NPI:1417502824
Name:JORDAN ENDRES DDS, LLC
Entity Type:Organization
Organization Name:JORDAN ENDRES DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ENDRES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-286-1188
Mailing Address - Street 1:6850 E MCDOWELL RD UNIT 54
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3254
Mailing Address - Country:US
Mailing Address - Phone:480-286-1188
Mailing Address - Fax:
Practice Address - Street 1:10814 N 71ST PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5204
Practice Address - Country:US
Practice Address - Phone:480-991-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-03
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental