Provider Demographics
NPI:1912051400
Name:JOURDAN, THOMAS BRYON (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BRYON
Last Name:JOURDAN
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 1:120A W DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-4224
Mailing Address - Country:US
Mailing Address - Phone:918-256-6831
Mailing Address - Fax:918-256-1954
Practice Address - Street 1:120A W DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-4224
Practice Address - Country:US
Practice Address - Phone:918-256-6831
Practice Address - Fax:918-256-1954
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK53811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice