Provider Demographics
NPI:1700267440
Name:YORK, JORDAN D (DDS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:D
Last Name:YORK
Suffix:
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 1:1929 N WASHINGTON ST STE OO
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1695
Mailing Address - Country:US
Mailing Address - Phone:701-222-1286
Mailing Address - Fax:701-222-1009
Practice Address - Street 1:1929 N WASHINGTON ST STE OO
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1695
Practice Address - Country:US
Practice Address - Phone:701-222-1286
Practice Address - Fax:701-222-1009
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND22691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice