Individual
CODY JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5675 26TH AVE S STE 116, FARGO, ND 58104-8599
(701) 699-6966
(701) 929-5441
Mailing address
5675 26TH AVE S STE 116, FARGO, ND 58104-8599
(701) 699-6966
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2518
ND
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
S221
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2020
Last updated
01/27/2026
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