Provider Demographics
NPI:1497315758
Name:PAULSEN, JORDAN LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LYNN
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 METCALF AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3333
Mailing Address - Country:US
Mailing Address - Phone:913-851-5900
Mailing Address - Fax:913-851-5912
Practice Address - Street 1:14221 METCALF AVE STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-3333
Practice Address - Country:US
Practice Address - Phone:913-851-5900
Practice Address - Fax:913-851-5912
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist