Provider Demographics
NPI:1174947899
Name:JORDAN DENTAL PA
Entity type:Organization
Organization Name:JORDAN DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALDOON
Authorized Official - Middle Name:
Authorized Official - Last Name:ABID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-236-4651
Mailing Address - Street 1:415 S AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5395
Mailing Address - Country:US
Mailing Address - Phone:720-236-4651
Mailing Address - Fax:
Practice Address - Street 1:415 S AIRPORT DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5395
Practice Address - Country:US
Practice Address - Phone:720-236-4651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX276921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty