Provider Demographics
NPI:1821261843
Name:JORDAN, JOY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:ANN
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 1:4074 LEE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2165
Mailing Address - Country:US
Mailing Address - Phone:216-491-8100
Mailing Address - Fax:216-991-8660
Practice Address - Street 1:4074 LEE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2165
Practice Address - Country:US
Practice Address - Phone:216-491-8100
Practice Address - Fax:216-991-8660
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0716443Medicaid