Provider Demographics
NPI:1578948857
Name:JORDAN J. HUMBERT DDS PC
Entity Type:Organization
Organization Name:JORDAN J. HUMBERT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-407-1001
Mailing Address - Street 1:1001 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6047
Mailing Address - Country:US
Mailing Address - Phone:970-407-1001
Mailing Address - Fax:970-407-1581
Practice Address - Street 1:1001 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6047
Practice Address - Country:US
Practice Address - Phone:970-407-1001
Practice Address - Fax:970-407-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO201788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty