Provider Demographics
NPI:1245648724
Name:CHANDLER, JORDON (DMD)
Entity type:Individual
Prefix:DR
First Name:JORDON
Middle Name:
Last Name:CHANDLER
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 1:2341 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-7007
Mailing Address - Country:US
Mailing Address - Phone:706-245-5031
Mailing Address - Fax:
Practice Address - Street 1:2341 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-7007
Practice Address - Country:US
Practice Address - Phone:706-245-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist