Provider Demographics
NPI:1841740149
Name:JORDAN LEDGER, DDS, PC
Entity Type:Organization
Organization Name:JORDAN LEDGER, DDS, PC
Other - Org Name:CHICAGO ORAL SURGERY & IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-321-1394
Mailing Address - Street 1:1229 W WASHINGTON BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2132
Mailing Address - Country:US
Mailing Address - Phone:312-620-1926
Mailing Address - Fax:
Practice Address - Street 1:1229 W WASHINGTON BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2132
Practice Address - Country:US
Practice Address - Phone:312-620-1926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190287191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty