Individual
DR. JORDAN GHIASSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2100 CALLE DE LA VUELTA UNIT E101, SANTA FE, NM 87505-4819
(505) 988-5752
Mailing address
2100 CALLE DE LA VUELTA UNIT E101, SANTA FE, NM 87505-4819
(505) 988-5752
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DD4342
NM
1223P0300X
Periodontics
Primary
DD4342
NM
Other
Enumeration date
07/17/2015
Last updated
01/11/2021
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