Provider Demographics
NPI:1568684405
Name:JORDETH, WILLIAM T (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:JORDETH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14475 RIVER OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921
Mailing Address - Country:US
Mailing Address - Phone:719-481-2849
Mailing Address - Fax:719-531-7640
Practice Address - Street 1:1710 BRIARGATE BLVD.-SUITE 847
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-531-0636
Practice Address - Fax:719-531-7640
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1044731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice