Provider Demographics
NPI:1649903477
Name:CARPENTER, JORDAN (RDH)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 AMHERST ST STE L02
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3346
Mailing Address - Country:US
Mailing Address - Phone:540-773-3282
Mailing Address - Fax:
Practice Address - Street 1:1705 AMHERST ST STE L02
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3346
Practice Address - Country:US
Practice Address - Phone:540-773-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402208689124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist