Scott Richard Jordan, DMD | |
201 S Paradise Ave, Middleton, ID 83644-5809 | |
(208) 585-0048 | |
(208) 466-5359 |
Full Name | Scott Richard Jordan |
---|---|
Gender | Male |
Speciality | Dentist |
Location | 201 S Paradise Ave, Middleton, Idaho |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1639866213 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 13346887-9923 (Utah) | Secondary |
122300000X | Dentist | D-5558 (Idaho) | Primary |
Entity Name | Community Health Clinics Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1457309122 PECOS PAC ID: 4082527353 Enrollment ID: O20040130000055 |
Mailing Address | Practice Location Address |
---|---|
Scott Richard Jordan, DMD Po Box 9, Nampa, ID 83653-0009 Ph: (208) 467-4431 | Scott Richard Jordan, DMD 201 S Paradise Ave, Middleton, ID 83644-5809 Ph: (208) 585-0048 |
Ashley Clarence Smith, DMD Dentist Medicare: Medicare Enrolled Practice Location: 201 S Paradise Ave, Middleton, ID 83644 Phone: 208-585-0048 Fax: 208-466-5359 | |
Dr. Philip Openshaw, D.D.S. Dentist Medicare: Medicare Enrolled Practice Location: 201 S Paradise Ave, Middleton, ID 83644 Phone: 208-585-0048 Fax: 208-466-5359 | |
Dr. Aries J Ganir, DMD Dentist Medicare: Not Enrolled in Medicare Practice Location: 1064 W. Main Street, Middleton, ID 83644 Phone: 208-585-9200 | |
Rustin G Hawker, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 509 S Middleton Rd Ste 101, Middleton, ID 83644 Phone: 208-921-5420 |