Individual
JORDAN JACOB ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
401 RAILROAD ST W, MISSOULA, MT 59802-4109
(406) 258-4789
Mailing address
415 ERIE ST SE APT 302, MINNEAPOLIS, MN 55414-3047
(218) 850-0590
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17391
MT
Other
Enumeration date
06/21/2019
Last updated
06/21/2019
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