NPIMap

Organization Active NPI

John R Jordan DDS PA

  • General Practice Dentistry
  • Detroit Lakes, MN
National Provider Identifier
1609008051
Registry record updated Aug 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D10689 Issued in MN
Legal business name
JOHN R JORDAN DDS PA
Practice address
1106 W River Rd
Detroit Lakes, MN 56501-2723
Phone
(218) 846-1900
Fax
(218) 847-5079
NPI assigned
Aug 19, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2009

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

Authorized official

Name
Dr. John R Jordan, DDSNPI 1417963695
Title
Owner
Phone
(218) 846-1900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D10689 MN Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X D12441 MN

Addresses

Primary practice location

1106 W River Rd
Detroit Lakes, MN 56501-2723

Mailing address

1106 W River Rd
Detroit Lakes, MN 56501-2723
Phone (218) 846-1900

Other names 1

  • West River Dental Other name

National Provider Directory

National Provider Directory

Locations

1106 W River Rd
Detroit Lakes, MN 56501
Phone (218) 846-1900

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1250640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250640000000",
    "number": "1609008051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 W RIVER RD",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012723",
            "telephone_number": "218-846-1900",
            "fax_number": "218-847-5079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 W RIVER RD",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012723",
            "telephone_number": "218-846-1900",
            "fax_number": "218-847-5079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN R JORDAN DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-19",
        "last_updated": "2009-08-19",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-846-1900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D10689",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12441",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West River Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Detroit Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2009; 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.