Provider Demographics
NPI:1013447879
Name:JASON H NORDEAN DDS PLLC
Entity Type:Organization
Organization Name:JASON H NORDEAN DDS PLLC
Other - Org Name:JASON H NORDEAN DDS PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTAIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:H
Authorized Official - Last Name:NORDEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-650-1700
Mailing Address - Street 1:1950 W INDIAN SCHOOL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5114
Mailing Address - Country:US
Mailing Address - Phone:602-650-1700
Mailing Address - Fax:602-650-1704
Practice Address - Street 1:1950 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 6
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-650-1700
Practice Address - Fax:602-650-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty