Provider Demographics
NPI:1629269717
Name:ROBERT M. JOURDAN, D.D.S., P.C.
Entity Type:Organization
Organization Name:ROBERT M. JOURDAN, D.D.S., P.C.
Other - Org Name:ALWAYS GREAT SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/ EXEC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-469-0296
Mailing Address - Street 1:586 DUANE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4639
Mailing Address - Country:US
Mailing Address - Phone:630-469-0296
Mailing Address - Fax:630-545-9155
Practice Address - Street 1:586 DUANE ST STE 301
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4639
Practice Address - Country:US
Practice Address - Phone:630-469-0296
Practice Address - Fax:630-545-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.0024971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty