Jordan Tyler Franklin
Dentist, General Practice in Maywood, IL. Individual provider (NPI-1).
NPI number1124605415
StatusActive
Last updated in NPPESNov 7, 2021
Details
- NPI
- 1124605415
- Entity type
- Individual (NPI-1)
- Name
- Jordan Tyler Franklin
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Mar 24, 2021
- Certification date
- Nov 7, 2021
- Last updated
- Nov 7, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 019.033138 | IL | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
2160 S 1st Ave Ste 2840-AMaywood, IL 60153-3328
Phone 708-216-4533
Mailing address
2160 S 1st Ave Ste 2840-AMaywood, IL 60153-3328
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