Dennis Jordan Widman in San Jose - Orthodontics And Dentofacial Orthopedics
Dennis Jordan Widman - NPI 1124148929
Dennis Jordan Widman is a Orthodontics And Dentofacial Orthopedics in San Jose, California. Dennis Jordan Widman practices all healthcare services and medical treatments related to Orthodontics And Dentofacial Orthopedics. The NPI Number for Dennis Jordan Widman is 1124148929. The last update date is 2007-07-08.
Dennis Jordan Widman's current location address is 4860 Cherry Ave, San Jose, California. You can contact this provider via phone number 4082654480 and fax number 4089972946. The mailing address for Dennis Jordan Widman is 4860 Cherry Ave, San Jose, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Dennis Jordan Widman |
|---|---|
| Address | 4860 Cherry Ave, San Jose, California |
| Phone Number | 4082654480 |
| Fax Number | 4089972946 |
| Sole Proprietor | Y |
| Credentials | DDS |
NPI Number Detail
| NPI Number | 1124148929 |
|---|---|
| Provider Enumeration Date | 2007-03-29 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 4860 Cherry Ave |
|---|---|
| City | San Jose |
| State | California (CA) |
| Post Code | 951183716 |
| Phone Number | 4082654480 |
| Fax Number | 4089972946 |
Provider's Primary Taxonomy Detail
| Speciality | Orthodontics And Dentofacial Orthopedics |
|---|---|
| Taxonomy | 1223X0400X |
| Licence No | 18666 |
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Definition: That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their rel |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| D18666 | CA | DENTICAL |
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What is the unique 10-digit identifier code issued to Dennis Jordan Widman by the Centers for Medicare & Medicaid Services?
The Dennis Jordan Widman has been assigned the NPI (National Provider Identifier) 1124148929 by the CMS (Centers for Medicare & Medicaid Services). This 10-digit code serves as a unique identification number for healthcare providers.
Can you provide the Dennis Jordan Widman's physical address?
The Dennis Jordan Widman is physically located at 4860 Cherry Ave, in the city of San Jose, CA, with the postal code 951183716.
What is the Dennis Jordan Widman's specialty and taxonomy code?
The Dennis Jordan Widman's specialty is Orthodontics And Dentofacial Orthopedics, and the corresponding taxonomy code is 1223X0400X.
On what date did the Centers for Medicare & Medicaid Services issue the 1124148929 to Dennis Jordan Widman?
The Dennis Jordan Widman received its 1124148929 assignment from the Centers for Medicare & Medicaid Services on 2007-03-29.
As of what date were the Dennis Jordan Widman's details last updated?
The information pertaining to the Dennis Jordan Widman, including its address, specialty, and other details, was most recently updated on 2007-07-08.