Provider Demographics
NPI:1912090705
Name:JORDAN, SCHARIE T (DMD)
Entity Type:Individual
Prefix:
First Name:SCHARIE
Middle Name:T
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-1029
Mailing Address - Country:US
Mailing Address - Phone:787-796-7301
Mailing Address - Fax:787-796-9672
Practice Address - Street 1:MARGINAL COSTA DE ORO C3
Practice Address - Street 2:SUITE 12
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-796-7301
Practice Address - Fax:787-796-9672
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRLIC #2189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist