Individual
DR. DAVID SCOTT JARDENIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3204 LANCER ST, STE. B, PORTAGE, IN 46368-4490
(219) 762-1806
(219) 763-9979
Mailing address
3204 LANCER ST, STE. B, PORTAGE, IN 46368-4490
(219) 762-1806
(219) 763-9979
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12008911
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200178640
—
IN
01
—
901629
UNITED CONCORDIA
IN
Enumeration date
11/09/2006
Last updated
07/08/2007
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