Active NPI
Terrance Kraig Jorden, DDS
- General Practice Dentistry
- Stockbridge, GA
National Provider Identifier
1811007602
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN012518
- Practice address
- 105 North Park TRL So
Suite 100
Stockbridge, GA 30281 - Phone
- (678) 289-8004
- Fax
- (678) 565-9696
- NPI assigned
- Aug 30, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN012518 | GA | Primary |
Addresses
Primary practice location
105 North Park TRL So
Suite 100
Stockbridge, GA 30281
Mailing address
105 North Park TRL So
Suite 100
Stockbridge, GA 30281
Phone (678) 289-8004
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 |
|---|---|---|---|
| DN012518 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811007602",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 NORTH PARK TRL SO",
"address_2": "SUITE 100",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "30281",
"telephone_number": "678-289-8004",
"fax_number": "678-565-9696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 NORTH PARK TRL SO",
"address_2": "SUITE 100",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "30281",
"telephone_number": "678-289-8004",
"fax_number": "678-565-9696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDEN",
"first_name": "TERRANCE",
"middle_name": "KRAIG",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN012518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
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.