Provider Demographics
NPI:1528877388
Name:JORDAN PERRIMAN DDS LLC
Entity type:Organization
Organization Name:JORDAN PERRIMAN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-802-2412
Mailing Address - Street 1:2109 NE 72ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-7903
Mailing Address - Country:US
Mailing Address - Phone:816-452-3420
Mailing Address - Fax:816-454-2777
Practice Address - Street 1:2109 NE 72ND ST STE 101
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-7903
Practice Address - Country:US
Practice Address - Phone:816-452-3420
Practice Address - Fax:816-454-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental