Individual
DASHIELL JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
99 CAMPUS AVE STE 201, LEWISTON, ME 04240-6045
(207) 777-8810
(207) 777-8155
Mailing address
PO BOX 1638, ALBANY, NY 12201-1638
(207) 777-4111
(207) 783-6660
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
TD171104
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053632901
—
ME
Enumeration date
06/15/2010
Last updated
07/21/2022
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