Provider Demographics
NPI:1588453484
Name:JORDAN, RODERICK QUENNEL JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:QUENNEL
Last Name:JORDAN
Suffix:JR
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 1:23 JAMESTOWN FARM DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1432
Mailing Address - Country:US
Mailing Address - Phone:314-780-8331
Mailing Address - Fax:
Practice Address - Street 1:40 WELDON PKWY
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3202
Practice Address - Country:US
Practice Address - Phone:314-254-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program