Provider Demographics
NPI:1710995774
Name:JORDAN, JANET LORRAINE (DDS)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LORRAINE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 S WARNER ELLIOT LP
Mailing Address - Street 2:STE #2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044
Mailing Address - Country:US
Mailing Address - Phone:480-598-3659
Mailing Address - Fax:480-598-9102
Practice Address - Street 1:12010 S WARNER ELLIOT LP
Practice Address - Street 2:STE #2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044
Practice Address - Country:US
Practice Address - Phone:480-598-3659
Practice Address - Fax:480-598-9102
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD42711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics