Provider Demographics
NPI:1013138445
Name:JORDAN, GLENWOOD BURNELL (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:GLENWOOD
Middle Name:BURNELL
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6958 GARTH RD
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-9646
Mailing Address - Country:US
Mailing Address - Phone:281-839-3202
Mailing Address - Fax:281-839-2021
Practice Address - Street 1:6958 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-9646
Practice Address - Country:US
Practice Address - Phone:281-839-3202
Practice Address - Fax:281-839-2021
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0105181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics