Provider Demographics
NPI:1942649504
Name:DOBMEIER, JORDAN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:THOMAS
Last Name:DOBMEIER
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 1:910 NEWPORT BEACH WAY UNIT 8
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-2546
Mailing Address - Country:US
Mailing Address - Phone:701-640-5355
Mailing Address - Fax:
Practice Address - Street 1:606 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9271
Practice Address - Country:US
Practice Address - Phone:406-446-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-5950122300000X
MT59501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist