Provider Demographics
NPI:1982279295
Name:JORDAN A. HEBERT, DMD, LLC
Entity Type:Organization
Organization Name:JORDAN A. HEBERT, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPOUSE OF OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-229-6268
Mailing Address - Street 1:5190 MEDFORD DR # 100
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5190 MEDFORD DR # 100
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2102
Practice Address - Country:US
Practice Address - Phone:205-582-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental