Individual
JOE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
521 CENTER AVE N, PHILADELPHIA, MS 39350-2551
(601) 656-4732
(601) 656-5885
Mailing address
521 CENTER AVE N, PHILADELPHIA, MS 39350-2551
(601) 656-4732
(601) 656-5885
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1757-77
MS
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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