Provider Demographics
NPI:1669866695
Name:JORDAN PRIETO DDS, INC.
Entity Type:Organization
Organization Name:JORDAN PRIETO DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-906-0209
Mailing Address - Street 1:6245 N FRESNO ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5270
Mailing Address - Country:US
Mailing Address - Phone:559-554-9999
Mailing Address - Fax:
Practice Address - Street 1:6245 N FRESNO ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5270
Practice Address - Country:US
Practice Address - Phone:559-554-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty