Provider Demographics
NPI:1487963278
Name:JORDAN LANDING DENTAL CARE, PC
Entity type:Organization
Organization Name:JORDAN LANDING DENTAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:VAUGHN
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-280-7001
Mailing Address - Street 1:7611 JORDAN LANDING BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-5613
Mailing Address - Country:US
Mailing Address - Phone:801-280-7001
Mailing Address - Fax:801-280-7076
Practice Address - Street 1:7611 JORDAN LANDING BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-5613
Practice Address - Country:US
Practice Address - Phone:801-280-7001
Practice Address - Fax:801-280-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3579701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty