Provider Demographics
NPI:1861657579
Name:HEALTHY KIDS FIRST
Entity Type:Organization
Organization Name:HEALTHY KIDS FIRST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-254-5601
Mailing Address - Street 1:5963 CALAIS CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-6004
Mailing Address - Country:US
Mailing Address - Phone:317-562-1260
Mailing Address - Fax:317-562-1356
Practice Address - Street 1:5963 CALAIS CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-6004
Practice Address - Country:US
Practice Address - Phone:317-562-1260
Practice Address - Fax:317-562-1356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008913122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200246650OtherPROVIDER NUMBER