Provider Demographics
NPI:1255992889
Name:PERRIMAN, JORDAN A (DDS)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:A
Last Name:PERRIMAN
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 1:2109 NE 72ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-7903
Mailing Address - Country:US
Mailing Address - Phone:816-452-3420
Mailing Address - Fax:816-454-2777
Practice Address - Street 1:2109 NE 72ND ST STE 101
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-7903
Practice Address - Country:US
Practice Address - Phone:816-452-3420
Practice Address - Fax:816-454-2777
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190207161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice