Organization
ASHVILLE FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BRENT JORDAN D.M.D. (OWNER)
(205) 594-5044
Entity
Organization
Contact information
Practice address
279 5TH AVE, ASHVILLE, AL 35953-3339
(205) 594-5044
Mailing address
PO BOX 129, ASHVILLE, AL 35953-0129
(205) 594-5044
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
5192
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009955935
—
AL
Enumeration date
03/03/2016
Last updated
03/03/2016
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