Provider Demographics
NPI:1689908840
Name:COUNCILL, JORDAN HUNTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:HUNTER
Last Name:COUNCILL
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 1:385 BRADFORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-6535
Mailing Address - Country:US
Mailing Address - Phone:828-398-4910
Mailing Address - Fax:
Practice Address - Street 1:10 BROOK ST STE 215
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-5500
Practice Address - Country:US
Practice Address - Phone:828-398-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912858Medicaid