Provider Demographics
NPI:1295358943
Name:DUARTE, JORDAN MICHELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:MICHELLE
Last Name:DUARTE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:NOSIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:40470 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18900 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2669
Practice Address - Country:US
Practice Address - Phone:248-565-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016012731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry