Provider Demographics
NPI:1619212966
Name:JORDAN, MARK FRANKLIN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:FRANKLIN
Last Name:JORDAN
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:PO BOX 130939
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92013-0939
Mailing Address - Country:US
Mailing Address - Phone:760-438-0948
Mailing Address - Fax:760-438-7821
Practice Address - Street 1:6120 PASEO DEL NORTE
Practice Address - Street 2:K1
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1150
Practice Address - Country:US
Practice Address - Phone:760-438-0948
Practice Address - Fax:760-438-7821
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice