Provider Demographics
NPI:1184725426
Name:NORDEAN, JASON H (DDS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:H
Last Name:NORDEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5109
Mailing Address - Country:US
Mailing Address - Phone:602-650-1700
Mailing Address - Fax:
Practice Address - Street 1:4245 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5109
Practice Address - Country:US
Practice Address - Phone:602-650-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0086571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028155Medicaid
OR028155OtherOFFICE OF MEDICAL ASS