Thomas David Jordan, DDS Valid NPI
Individual provider · General Practice Dentistry · O Fallon, MO
- NPI
- 1578803706
- Type
- Individual (Type 1)
- Primary specialty
- General Practice Dentistry (Dentist)
- Specialty group
- Dental Providers
- Taxonomy code
- 1223G0001X
- License number
- 15009 (MO)
- Sex
- Male
- Sole proprietor
- Yes
- Enumerated
- 2013-02-25
- Last updated
- 2013-02-25
Practice location
346 Fort Zumwalt Sq
O Fallon, MO 63366-3065
(636) 978-6400