Provider Demographics
NPI:1811046170
Name:JORDAN RIVER DENTAL
Entity Type:Organization
Organization Name:JORDAN RIVER DENTAL
Other - Org Name:ROCKINGHAM DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALABBADI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-463-1915
Mailing Address - Street 1:1 HOSPITAL COURT
Mailing Address - Street 2:
Mailing Address - City:BELLOWS FALLS
Mailing Address - State:VT
Mailing Address - Zip Code:05101
Mailing Address - Country:US
Mailing Address - Phone:802-463-1915
Mailing Address - Fax:802-463-4937
Practice Address - Street 1:1 HOSPITAL COURT
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101
Practice Address - Country:US
Practice Address - Phone:802-463-1915
Practice Address - Fax:802-463-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600021471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty