Active NPI
Andrea L Jordan, A.D.T.
- Dental Therapist
- Saint Paul, MN
National Provider Identifier
1912331265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Therapist
- License
- DT28
- Practice address
- 895 7TH St E
Saint Paul, MN 55106 - Phone
- (651) 602-7500
- NPI assigned
- Aug 22, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | H5837 | MN | |
| Dental Therapist | 125J00000X | DT28 | MN | Primary |
Addresses
Primary practice location
895 7TH St E
Saint Paul, MN 55106
Mailing address
366 Hall Ave
Saint Paul, MN 55107-1132
Phone (651) 698-3185
Other practice location 1
636 Broadway St NE
Minneapolis, MN 55413-2164
Phone (612) 746-1530 ext. 207
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 |
|---|---|---|---|
| H5837 | MN | MD | Dental Hygienist |
| DT28 | MN | MD | Dental Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Dental Services | Past | Accepting new patients | |
| Childrens Dental Services Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Public Health Dentistry
- Chisholm, MN
- NPI 1669842662
-
- Public Health Dentistry
- Minneapolis, MN
- NPI 1407973605
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529539200000",
"number": "1912331265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "366 HALL AVE",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551071132",
"telephone_number": "651-698-3185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "895 7TH ST E",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "55106",
"telephone_number": "651-602-7500"
}
],
"practiceLocations": [
{
"address_1": "636 Broadway St NE",
"address_purpose": "LOCATION",
"city": "Minneapolis",
"state": "MN",
"postal_code": "554132164",
"country_code": "US",
"telephone_number": "612-746-1530 x207",
"fax_number": "612-746-1531",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JORDAN",
"first_name": "ANDREA",
"middle_name": "L",
"credential": "A.D.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-22",
"last_updated": "2018-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MN",
"license": "H5837",
"primary": false
},
{
"code": "125J00000X",
"taxonomy_group": "",
"desc": "Dental Therapist",
"state": "MN",
"license": "DT28",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.