Individual
NANCY WISE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
108 6TH ST, GROTTOES, VA 24441
(540) 249-4242
(540) 249-4732
Mailing address
PO BOX 308, 108 6TH ST, GROTTOES, VA 24441
(540) 249-4242
(540) 249-4732
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401006821
VA
Other
Enumeration date
08/02/2006
Last updated
07/08/2007
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