Organization
JOHN R JORDAN DDS PA
Active
Other names
West River Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN R JORDAN DDS (OWNER)
(218) 846-1900
Entity
Organization
Contact information
Practice address
1106 W RIVER RD, DETROIT LAKES, MN 56501-2723
(218) 846-1900
(218) 847-5079
Mailing address
1106 W RIVER RD, DETROIT LAKES, MN 56501-2723
(218) 846-1900
(218) 847-5079
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10689
MN
1223G0001X
General Practice Dentistry
D12441
MN
Other
Enumeration date
08/19/2009
Last updated
08/19/2009
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