Provider Demographics
NPI:1891267456
Name:MDC DENTAL, LLC
Entity Type:Organization
Organization Name:MDC DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-459-5310
Mailing Address - Street 1:135 E MARKET ST STE 116
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-1369
Mailing Address - Country:US
Mailing Address - Phone:724-459-5310
Mailing Address - Fax:724-459-5848
Practice Address - Street 1:135 E MARKET ST STE 116
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-1369
Practice Address - Country:US
Practice Address - Phone:724-459-5310
Practice Address - Fax:724-459-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental