Active NPI
Luke Jordan
- General Practice Dentistry
- New Iberia, LA
National Provider Identifier
1174937312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6491
- Practice address
- 2217 Old Jeanerette Rd
New Iberia, LA 70563-8687 - Phone
- (337) 321-5651
- NPI assigned
- Jun 16, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6491 | LA | Primary |
Addresses
Primary practice location
2217 Old Jeanerette Rd
New Iberia, LA 70563-8687
Mailing address
3601 Kaliste Saloom Rd Unit 107
Lafayette, LA 70508-7633
Phone (337) 356-6845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- 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 |
|---|---|---|---|---|
| I20150605001159 | LA | Order and Referring Only - Dentist | 2668793308 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402876800000",
"number": "1174937312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3601 KALISTE SALOOM RD UNIT 107",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705087633",
"telephone_number": "337-356-6845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2217 OLD JEANERETTE RD",
"city": "NEW IBERIA",
"state": "LA",
"postal_code": "705638687",
"telephone_number": "337-321-5651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "LUKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-16",
"last_updated": "2014-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "6491",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Iberia, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; 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.