Provider Demographics
NPI:1740476472
Name:JORDAN, EMILY REBECCA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:REBECCA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:REBECCA
Other - Last Name:TOLLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:652 WEST CENTRAL AVE
Mailing Address - Street 2:SUITE 80
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015
Mailing Address - Country:US
Mailing Address - Phone:740-369-4550
Mailing Address - Fax:740-363-3546
Practice Address - Street 1:652 WEST CENTRAL AVE
Practice Address - Street 2:SUITE 80
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015
Practice Address - Country:US
Practice Address - Phone:740-369-4550
Practice Address - Fax:740-363-3546
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300224921223P0700X
OH30-0224921223P0700X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics