Individual provider Active NPI

Robert Milton Jourdan, D.D.S.

  • General Practice Dentistry
  • Glen Ellyn, IL
National Provider Identifier
1396858221
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
586 Duane St Ste 301
Glen Ellyn, IL 60137-4639
Phone
(630) 469-0296
Fax
(630) 545-9155
NPI assigned
Aug 16, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IL Primary

Addresses

Primary practice location

586 Duane St Ste 301
Glen Ellyn, IL 60137-4639

Mailing address

22W301 Ahlstrand Rd
Glen Ellyn, IL 60137-7150
Phone (630) 858-7976

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-013145ILMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396858221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22W301 AHLSTRAND RD",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601377150",
            "telephone_number": "630-858-7976",
            "fax_number": "630-545-9155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "586 DUANE ST STE 301",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601374639",
            "telephone_number": "630-469-0296",
            "fax_number": "630-545-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOURDAN",
        "first_name": "ROBERT",
        "middle_name": "MILTON",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ellyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.