Individual
CLINT R JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
130 WEST OLD HIGHWAY 2, MERNA, NE 68856
(308) 643-2255
Mailing address
44080 DR 796, BROKEN BOW, NE 68822-4256
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6837
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026061400
—
NE
Enumeration date
09/09/2009
Last updated
09/22/2011
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