Provider Demographics
NPI:1922784297
Name:JORDAN, HANNAH LEANN (DMD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LEANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 PRESERVE CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-6050
Mailing Address - Country:US
Mailing Address - Phone:803-968-6131
Mailing Address - Fax:
Practice Address - Street 1:208 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3916
Practice Address - Country:US
Practice Address - Phone:843-355-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.105471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice