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Contact Information

SCOTT R JORDAN, DMD
201 S PARADISE AVE
MIDDLETON, ID83644-5809
 Phone: 208-585-0048
 Fax: 208-466-5359
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for SCOTT R JORDAN · (Male)

NPI Number 1639866213
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 04/24/2023
Last updated 06/23/2025 - About 12 months ago
Sole proprietor 1 Yes
Identifiers
  • ID License # D-5558
  • UT License # 13346887-9923
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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