Provider Demographics
NPI:1497889117
Name:JORDAN, DONALD CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:CHARLES
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1901 SO UNION
Mailing Address - Street 2:A232
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1709
Mailing Address - Country:US
Mailing Address - Phone:253-627-5959
Mailing Address - Fax:253-627-0258
Practice Address - Street 1:1901 SO UNION
Practice Address - Street 2:A232
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1709
Practice Address - Country:US
Practice Address - Phone:253-627-5959
Practice Address - Fax:253-627-0258
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000047551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics