Provider Demographics
NPI:1467085837
Name:BROOKE JORDAN DDS LLC
Entity Type:Organization
Organization Name:BROOKE JORDAN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:205-995-1450
Mailing Address - Street 1:101 MISSIONARY RDG STE 101
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5203
Mailing Address - Country:US
Mailing Address - Phone:205-995-1450
Mailing Address - Fax:205-981-0540
Practice Address - Street 1:101 MISSIONARY RDG STE 101
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5203
Practice Address - Country:US
Practice Address - Phone:205-995-1450
Practice Address - Fax:205-981-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental