Jordan Freeark, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

64081 Issued in CA

Practice address

674 Boulevard de France
Parris Island, SC 29905

Phone

(843) 228-2402

NPI assigned

Sep 19, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723593600000",
    "number": "1508268699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 BOLLING AVE UNIT 309",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235081612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "674 BOULEVARD DE FRANCE",
            "city": "PARRIS ISLAND",
            "state": "SC",
            "postal_code": "29905",
            "telephone_number": "843-228-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEARK",
        "first_name": "JORDAN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-19",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "64081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Desaulniers, P.A.
• Andrea DO
• Megan Marie Doll, PA-C
• Anthony Allen Dowell, IDC
• William Michael Duensing, DDS
• Matthew Gartner, DMD
• James Arthur Gibson, MS, ATC
• Benjamin Racine Gilles, DDS
• Alex T Gray, DDS
• Grason Joseph Hadfield, DMD

• Oral and Maxillofacial Surgery (Dentist) in Parris Island, SC
• Providers in Parris Island, SC by specialty
• Oral and Maxillofacial Surgery (Dentist) in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2024; 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.