Provider Demographics
NPI:1679186985
Name:BARNETT, JORDAN (DDS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BARNETT
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 1:290 SHAW AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3854
Mailing Address - Country:US
Mailing Address - Phone:559-298-3024
Mailing Address - Fax:559-298-3026
Practice Address - Street 1:290 SHAW AVE STE C
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3854
Practice Address - Country:US
Practice Address - Phone:559-298-3024
Practice Address - Fax:559-298-3026
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist