Provider Demographics
NPI:1700050093
Name:MELANIE E. JORDAN, DDS, PC
Entity type:Organization
Organization Name:MELANIE E. JORDAN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-236-0539
Mailing Address - Street 1:816 STATE ST
Mailing Address - Street 2:FLOOR ONE
Mailing Address - City:CURWENSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16833-1039
Mailing Address - Country:US
Mailing Address - Phone:814-236-0539
Mailing Address - Fax:814-236-0443
Practice Address - Street 1:816 STATE ST
Practice Address - Street 2:FLOOR ONE
Practice Address - City:CURWENSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16833-1039
Practice Address - Country:US
Practice Address - Phone:814-236-0539
Practice Address - Fax:814-236-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031357L1223G0001X
PADS029353L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015294680001Medicaid