Provider Demographics
NPI:1184160806
Name:BRITT, JORDAN MARIE (DMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:BRITT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S CRESTMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2736
Mailing Address - Country:US
Mailing Address - Phone:603-568-1738
Mailing Address - Fax:
Practice Address - Street 1:130 EVERGREEN RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:KY
Practice Address - Zip Code:40243-1480
Practice Address - Country:US
Practice Address - Phone:502-410-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry