Provider Demographics
NPI:1811125867
Name:JORDAN, ELVA VILLA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELVA
Middle Name:VILLA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7002 MCPHERSON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6418
Mailing Address - Country:US
Mailing Address - Phone:956-725-5035
Mailing Address - Fax:956-717-4106
Practice Address - Street 1:7002 MCPHERSON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6418
Practice Address - Country:US
Practice Address - Phone:956-725-5035
Practice Address - Fax:956-717-4106
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX250771223P0221X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program