Provider Demographics
NPI:1891790655
Name:JORDEN, LEANNA GWEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:GWEN
Last Name:JORDEN
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 1:5301 50TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-5834
Mailing Address - Country:US
Mailing Address - Phone:806-797-7078
Mailing Address - Fax:806-792-3739
Practice Address - Street 1:5301 50TH ST
Practice Address - Street 2:STE 300
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-5834
Practice Address - Country:US
Practice Address - Phone:806-797-7078
Practice Address - Fax:806-792-3739
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice