Individual
SCOTT RICHARD JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
201 S PARADISE AVE, MIDDLETON, ID 83644-5809
(208) 585-0048
(208) 466-5359
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0434
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
13346887-9923
UT
122300000X
Dentist
Primary
D-5558
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/24/2023
Last updated
06/23/2025
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