Provider Demographics
NPI:1477654515
Name:JORDAN, TIMOTHY HAROLD (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:HAROLD
Last Name:JORDAN
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 1:23111 VENTURA BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-225-7768
Mailing Address - Fax:
Practice Address - Street 1:23111 VENTURA BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:805-499-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2015-03-13
Deactivation Date:2012-02-07
Deactivation Code:
Reactivation Date:2015-03-13
Provider Licenses
StateLicense IDTaxonomies
CA285751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice