Provider Demographics
NPI:1528181732
Name:JORDAN, JENE F (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JENE
Middle Name:F
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 BALFOUR DR
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-3117
Mailing Address - Country:US
Mailing Address - Phone:336-431-7373
Mailing Address - Fax:336-431-4009
Practice Address - Street 1:209 BALFOUR DR
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-3117
Practice Address - Country:US
Practice Address - Phone:336-431-7373
Practice Address - Fax:336-431-4009
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics