Provider Demographics
NPI:1972814820
Name:HESTER, JORDAN (DMD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HESTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-2200
Mailing Address - Country:US
Mailing Address - Phone:239-658-3000
Mailing Address - Fax:239-658-3175
Practice Address - Street 1:7505 GRAND LELY DR BLDG L
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-1753
Practice Address - Country:US
Practice Address - Phone:239-775-3052
Practice Address - Fax:239-775-7035
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL190831223D0001X
FLDN190831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002509100Medicaid