Provider Demographics
NPI:1255643508
Name:PRIETO, JORDAN DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:DAVID
Last Name:PRIETO
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 1:7525 N CEDAR AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2698
Mailing Address - Country:US
Mailing Address - Phone:559-439-6600
Mailing Address - Fax:
Practice Address - Street 1:7525 N CEDAR AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2698
Practice Address - Country:US
Practice Address - Phone:559-439-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA613091223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry