Provider Demographics
NPI:1942578349
Name:POSS, JORDAN LEE (DDS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEE
Last Name:POSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 MORTENSEN RD
Mailing Address - Street 2:#108
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-6227
Mailing Address - Country:US
Mailing Address - Phone:515-292-9014
Mailing Address - Fax:
Practice Address - Street 1:4611 MORTENSEN RD
Practice Address - Street 2:#108
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-6227
Practice Address - Country:US
Practice Address - Phone:515-292-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics