Provider Demographics
NPI:1508436999
Name:FREITAS, JORDANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDANA
Middle Name:
Last Name:FREITAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WESLEY MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-8338
Mailing Address - Country:US
Mailing Address - Phone:706-745-7100
Mailing Address - Fax:
Practice Address - Street 1:100 WESLEY MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-8338
Practice Address - Country:US
Practice Address - Phone:706-745-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist