Individual
DR. EDWARD T JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1612 HUGUENOT RD, MIDLOTHIAN, VA 23113-2427
(804) 794-9789
Mailing address
1612 HUGUENOT RD, MIDLOTHIAN, VA 23113-2427
(804) 794-9789
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401412867
VA
Other
Enumeration date
06/16/2010
Last updated
06/16/2010
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