Provider Demographics
NPI:1023419918
Name:HARPER, JORDAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:HARPER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 E HIGHWAY 20
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-9740
Mailing Address - Country:US
Mailing Address - Phone:850-897-4200
Mailing Address - Fax:850-897-4504
Practice Address - Street 1:4506 E HIGHWAY 20
Practice Address - Street 2:SUITE 100
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9740
Practice Address - Country:US
Practice Address - Phone:850-897-4200
Practice Address - Fax:850-897-4504
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN206561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice