Provider Demographics
NPI:1902024706
Name:JORDAN, ADAM BARNETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:BARNETT
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 SLAUGHTER RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8619
Mailing Address - Country:US
Mailing Address - Phone:256-830-5412
Mailing Address - Fax:
Practice Address - Street 1:1920 SLAUGHTER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8619
Practice Address - Country:US
Practice Address - Phone:256-830-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190272301223G0001X
AL54081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice