Active NPI
Daniel Richard Jordan, DDS
- Dentist
- Jacksonville, FL
National Provider Identifier
1477281012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DEN.00205296
- Practice address
- Navy Medicine Support Command Attn: Medical Staff SVCS
BLDG H 2005 Knight Lane
Jacksonville, FL 32212-0140 - Phone
- (725) 760-3213
- NPI assigned
- Aug 11, 2022
- 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 | DEN.00205296 | CO | Primary |
Addresses
Primary practice location
Navy Medicine Support Command Attn: Medical Staff SVCS
BLDG H 2005 Knight Lane
Jacksonville, FL 32212-0140
Mailing address
26450 Ridge Vale Dr
Santa Clarita, CA 91321-2222
Phone (661) 361-6986
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 |
|---|---|---|---|
| DEN.00205296 | CO | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660176000000",
"number": "1477281012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26450 RIDGE VALE DR",
"city": "SANTA CLARITA",
"state": "CA",
"postal_code": "913212222",
"telephone_number": "661-361-6986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS",
"address_2": "BLDG H 2005 KNIGHT LANE",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322120140",
"telephone_number": "725-760-3213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "DANIEL",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-08-11",
"last_updated": "2022-08-11",
"certification_date": "2022-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "DEN.00205296",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.