Provider Demographics
NPI:1801201017
Name:ARNELL, JORDAN S (DMD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:S
Last Name:ARNELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 N BUTLER AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-0816
Mailing Address - Country:US
Mailing Address - Phone:505-327-0044
Mailing Address - Fax:
Practice Address - Street 1:800 E 30TH ST BLDG 3
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9407
Practice Address - Country:US
Practice Address - Phone:505-327-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist