Provider Demographics
NPI:1184304677
Name:CAREY, JORDAN (DMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CAREY
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:PO BOX 2433
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32041-2433
Mailing Address - Country:US
Mailing Address - Phone:904-206-3214
Mailing Address - Fax:
Practice Address - Street 1:10991 SAN JOSE BLVD UNIT 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6675
Practice Address - Country:US
Practice Address - Phone:904-380-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN283101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice