Provider Demographics
NPI:1639429442
Name:JORDAN HILLIS D.D.S. PA
Entity type:Organization
Organization Name:JORDAN HILLIS D.D.S. PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:HILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-898-8888
Mailing Address - Street 1:96 WEBSTER DR
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-9103
Mailing Address - Country:US
Mailing Address - Phone:870-898-8888
Mailing Address - Fax:870-898-4650
Practice Address - Street 1:96 WEBSTER DR
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-9103
Practice Address - Country:US
Practice Address - Phone:870-898-8888
Practice Address - Fax:870-898-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty