Provider Demographics
NPI:1669024063
Name:ARDOIN, JORDAN WADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:WADE
Last Name:ARDOIN
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 1:4510 CROSLEY LN
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-4931
Mailing Address - Country:US
Mailing Address - Phone:915-261-9837
Mailing Address - Fax:
Practice Address - Street 1:4741 BUFFALO GAP RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3304
Practice Address - Country:US
Practice Address - Phone:325-437-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist