Provider Demographics
NPI:1871756601
Name:HUGH F. JORDAN, D.D.S., P.C.
Entity type:Organization
Organization Name:HUGH F. JORDAN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-537-7211
Mailing Address - Street 1:401 DURDEN ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4600
Mailing Address - Country:US
Mailing Address - Phone:912-537-7211
Mailing Address - Fax:912-537-1011
Practice Address - Street 1:401 DURDEN ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4600
Practice Address - Country:US
Practice Address - Phone:912-537-7211
Practice Address - Fax:912-537-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00089702BMedicaid
GA00089702BMedicaid
GA19NCBZDMedicare Oscar/Certification