Provider Demographics
NPI:1255024295
Name:JORDAN FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:JORDAN FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FERRAZ-SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-492-2021
Mailing Address - Street 1:301 EL DORADO DRIVE
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352
Mailing Address - Country:US
Mailing Address - Phone:952-492-2021
Mailing Address - Fax:952-492-6505
Practice Address - Street 1:301 EL DORADO DRIVE
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352
Practice Address - Country:US
Practice Address - Phone:952-492-2021
Practice Address - Fax:952-492-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental