Provider Demographics
NPI:1528416567
Name:SINGER, JORDAN RUSSELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:RUSSELL
Last Name:SINGER
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 1:4411 BROWN RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9139
Mailing Address - Country:US
Mailing Address - Phone:541-200-6747
Mailing Address - Fax:541-779-0756
Practice Address - Street 1:4411 BROWN RIDGE TER
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9139
Practice Address - Country:US
Practice Address - Phone:541-200-6747
Practice Address - Fax:541-779-0756
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist