Provider Demographics
NPI:1649302860
Name:JORDAN, ANDREW B JR (DDS)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:JORDAN
Suffix:JR
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 1:1405 S JOHN REDDITT DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-4811
Mailing Address - Country:US
Mailing Address - Phone:936-632-6609
Mailing Address - Fax:936-637-3982
Practice Address - Street 1:1405 S JOHN REDDITT DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-4811
Practice Address - Country:US
Practice Address - Phone:936-632-6609
Practice Address - Fax:936-637-3982
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice