Teresa Danielle Jordan, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN012645 Issued in GA

Practice address

2646 Gresham Rd SE
Atlanta, GA 30316-4148

Phone

(404) 212-9060

Fax

(404) 212-9020

NPI assigned

Jun 13, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• East Atlanta Pediatric Dentistry PC

  • Pediatric Dentistry
  • Atlanta, GA
  • NPI 1740688142
  NPD (past) Authorized official

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487548800000",
    "number": "1780888693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MILANO DR SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303318381",
            "telephone_number": "770-449-0836",
            "fax_number": "770-441-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2646 GRESHAM RD SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303164148",
            "telephone_number": "404-212-9060",
            "fax_number": "404-212-9020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "TERESA",
        "middle_name": "DANIELLE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-13",
        "last_updated": "2017-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN012645",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "108964405",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Elizabeth Jordan, RN, IBCLC
• Rodney Dewayne Jordan Jr., AGACNP-BC
• Shamara Jordan
• Sophie Jordan
• Tanisha Jordan, BCBA
• Tiffany Jordan
• Tonya Jordan, M.D.
• Jordan'S Crossing Home Healthcare, LLC
• Erica Marlo Jorgensen
• Jose-Herick T Napenas

• Pediatric Dentistry in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; 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.