Active NPI
Jordan M Wirth, DDS
- Dentist
- Saint Cloud, FL
National Provider Identifier
1467025684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN26357
- Practice address
- 2301 Old Canoe Creek Rd
Saint Cloud, FL 34772-7706 - Phone
- (321) 805-4890
- NPI assigned
- Jul 24, 2021
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN26357 | FL | Primary |
Addresses
Primary practice location
2301 Old Canoe Creek Rd
Saint Cloud, FL 34772-7706
Mailing address
2301 Old Canoe Creek Rd
Saint Cloud, FL 34772-7706
Phone (321) 805-4890
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN26357 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627084800000",
"number": "1467025684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2301 OLD CANOE CREEK RD",
"city": "SAINT CLOUD",
"state": "FL",
"postal_code": "347727706",
"telephone_number": "321-805-4890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 OLD CANOE CREEK RD",
"city": "SAINT CLOUD",
"state": "FL",
"postal_code": "347727706",
"telephone_number": "321-805-4890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIRTH",
"first_name": "JORDAN",
"middle_name": "M",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-24",
"last_updated": "2021-07-24",
"certification_date": "2021-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN26357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.