Provider Demographics
NPI:1336361690
Name:JORDAN, LAKARA JOVARN (DDS)
Entity Type:Individual
Prefix:
First Name:LAKARA
Middle Name:JOVARN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 S ACADIAN THRUWAY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-5021
Mailing Address - Country:US
Mailing Address - Phone:225-256-4447
Mailing Address - Fax:225-256-4443
Practice Address - Street 1:332 S ACADIAN THRUWAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-5021
Practice Address - Country:US
Practice Address - Phone:225-256-4447
Practice Address - Fax:225-256-4443
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC9373OtherBCBS
LA1845558Medicaid