Organization
JORDAN LISSAUER ORTHODONTICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN LISSAUER DMD (PRESIDENT)
(561) 324-4030
Entity
Organization
Contact information
Practice address
3767 HYLAN BLVD, STATEN ISLAND, NY 10308-3505
(718) 966-2720
Mailing address
3767 HYLAN BLVD, STATEN ISLAND, NY 10308-3505
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
07/29/2019
Last updated
07/29/2019
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