Provider Demographics
NPI:1831244045
Name:DR. JORDAN TILDEN & ASSOCIATES
Entity type:Organization
Organization Name:DR. JORDAN TILDEN & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TILDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-664-6616
Mailing Address - Street 1:333 E ONTARIO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4804
Mailing Address - Country:US
Mailing Address - Phone:312-664-6616
Mailing Address - Fax:312-664-0515
Practice Address - Street 1:333 E ONTARIO ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4804
Practice Address - Country:US
Practice Address - Phone:312-664-6616
Practice Address - Fax:312-664-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A141681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL19A14168OtherDENTAL LISCENSE