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Contact Information

JORDAN E BROADDUS, DMD
6976 OLD CUSSETA HIGHWAY
FORT BENNING, GA31905
 Phone: 706-544-3176
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
 

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for JORDAN E BROADDUS · (Male)

NPI # 1083266639
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 07/14/2019
Last updated 03/08/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • KY License # 10326
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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