Individual
TERESA DANIELLE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2646 GRESHAM RD SE, ATLANTA, GA 30316-4148
(404) 212-9060
(404) 212-9020
Mailing address
150 MILANO DR SW, ATLANTA, GA 30331-8381
(770) 449-0836
(770) 441-0299
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012645
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108964405
—
GA
Enumeration date
06/13/2007
Last updated
02/20/2017
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