Provider Demographics
NPI:1447266374
Name:PIRTLE, JORDAN PATRICK (DDS)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:PATRICK
Last Name:PIRTLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 N EXPRESSWAY
Mailing Address - Street 2:STE. E
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4334
Mailing Address - Country:US
Mailing Address - Phone:956-350-0059
Mailing Address - Fax:
Practice Address - Street 1:4920 N EXPRESSWAY
Practice Address - Street 2:STE. E
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4334
Practice Address - Country:US
Practice Address - Phone:956-350-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist