Individual
DR. JORDAN E BROADDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
6976 OLD CUSSETA HIGHWAY, FT BENNING, GA 31905
(706) 544-3176
Mailing address
6976 OLD CUSSETA HIGHWAY, FT BENNING, GA 31905
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10326
KY
1223G0001X
General Practice Dentistry
10326
KY
Other
Enumeration date
07/14/2019
Last updated
03/08/2023
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