Jordan E Broaddus, DMD Valid NPI
Individual provider · Dentist · Ft Benning, GA
- NPI
- 1083266639
- Type
- Individual (Type 1)
- Primary specialty
- Dentist
- Specialty group
- Dental Providers
- Taxonomy code
- 122300000X
- License number
- 10326 (KY)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2019-07-14
- Last updated
- 2023-03-08
Practice location
6976 Old Cusseta Highway
Ft Benning, GA 31905
(706) 544-3176