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Individual
DR. CHARLES JORDAN
Active
Individual
DR. CHARLES JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN015930
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053162016
DRIVERS LICENSE
—
Enumeration date
09/05/2019
Last updated
11/12/2019
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