Provider Demographics
NPI:1649825852
Name:RIDGE, JORDAN (DDS)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:RIDGE
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 1:115 TURNBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8509
Mailing Address - Country:US
Mailing Address - Phone:910-695-3100
Mailing Address - Fax:
Practice Address - Street 1:115 TURNBERRY WAY
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8509
Practice Address - Country:US
Practice Address - Phone:910-695-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist