Individual
EBONY JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1427 MISSION ST, SOUTH PASADENA, CA 91030-3213
(626) 403-1800
Mailing address
1427 MISSION ST, SOUTH PASADENA, CA 91030-3213
(626) 669-4655
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12012022A
IN
1223P0221X
Pediatric Dentistry
12012022A
IN
1223P0221X
Pediatric Dentistry
Primary
DDS103462
CA
Other
Enumeration date
07/27/2010
Last updated
04/04/2024
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