Active NPI
Millard Dennis Jordan, DDS
- Dentist
- Detroit, MI
National Provider Identifier
1609993898
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901012336
- Practice address
- 17563 Greenfield
Detroit, MI 48235 - Phone
- (313) 272-0118
- Fax
- (313) 272-0488
- NPI assigned
- Mar 23, 2007
- 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 | 2901012336 | MI | Primary |
Addresses
Primary practice location
17563 Greenfield
Detroit, MI 48235
Mailing address
17563 Greenfield
Detroit, MI 48235
Phone (313) 272-0118
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4053791 | Medicaid | MI |
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 |
|---|---|---|---|
| 2901012336 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609993898",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17563 GREENFIELD",
"city": "DETROIT",
"state": "MI",
"postal_code": "48235",
"telephone_number": "313-272-0118",
"fax_number": "313-272-0488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17563 GREENFIELD",
"city": "DETROIT",
"state": "MI",
"postal_code": "48235",
"telephone_number": "313-272-0118",
"fax_number": "313-272-0488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "MILLARD",
"middle_name": "DENNIS",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901012336",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4053791",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
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.