# KEVIN R JORDAN DMD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447473939
- **Authorized official:** MR. KEVIN R JORDAN DMD (OWNER)
- **Authorized official phone:** (606) 286-4121

## Contact information

- **Practice address:** 154 SCOTT ST, OLIVE HILL, KY 41164
- **Practice address phone:** (606) 286-4121
- **Mailing address:** PO BOX 562, OLIVE HILL, KY 41164
- **Mailing address phone:** (606) 286-4121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 6868 | KY | Yes |

## Other

- **Enumeration date:** 04/11/2007
- **Last updated:** 09/03/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 60068681 | — | KY |