Active NPI
Jordan Donald Vice, DMD
- Dentist
- Kernersville, NC
National Provider Identifier
1083417471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 14284
- Practice address
- 633 Hopkins Rd
Kernersville, NC 27284-9379 - Phone
- (336) 543-0001
- NPI assigned
- Mar 31, 2025
- Last updated
- Apr 28, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 14284 | NC | Primary |
Addresses
Primary practice location
633 Hopkins Rd
Kernersville, NC 27284-9379
Mailing address
633 Hopkins Rd
Kernersville, NC 27284-9379
Phone (336) 543-0001
Other practice location 1
5923 W Friendly Ave
Greensboro, NC 27410-3207
Phone (336) 632-0744
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250709004255 | NC | Order and Referring Only - Dentist | 6204340375 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lane & Associates Xiii DDS PA | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Greensboro, NC
- NPI 1710031612
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777334400000",
"number": "1083417471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "633 HOPKINS RD",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272849379",
"telephone_number": "336-543-0001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 HOPKINS RD",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272849379",
"telephone_number": "336-543-0001"
}
],
"practiceLocations": [
{
"address_1": "5923 W Friendly Ave",
"address_purpose": "LOCATION",
"city": "Greensboro",
"state": "NC",
"postal_code": "274103207",
"country_code": "US",
"telephone_number": "336-632-0744",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VICE",
"first_name": "JORDAN",
"middle_name": "DONALD",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-03-31",
"last_updated": "2026-04-28",
"certification_date": "2026-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "14284",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.