DR. JORDAN BROADWATER DDS
NPI 1164317020
Dentist in Kingsport, TN

Q: What is Jordan Broadwater's NPI number?

The NPI number for Jordan Broadwater is 1164317020. It was assigned to this individual provider in the NPPES registry on June 11, 2025.

Q: What is Jordan Broadwater's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Jordan Broadwater was last updated on June 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 11, 2025

2701 BLOOMINGDALE RD, KINGSPORT, TN 37660(423) 288-8566 Get Directions Write a Review

NPPES record last updated: June 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. Jordan Broadwater Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JORDAN BROADWATER DDS (NPI 1164317020) is an individual dentist in Kingsport, Tennessee, licensed in Tennessee (12846) and active in the NPI registry since June 2025.

NPPES Registry Identity

NPI1164317020

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameDR. JORDAN BROADWATERCredential: DDS

Location Address2701 BLOOMINGDALE RDKingsport, TN 37660-1854

Mailing Address1024 Forrest Ridge DrKingsport, TN 37660-6628 · (423) 306-5052

Phone(423) 288-8566

Sole ProprietorYes

Enumeration DateJune 11, 2025

NPPES CertifiedJune 11, 2025

✔ NPI 1164317020 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in TN · 12846

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

2701 BLOOMINGDALE RD, Kingsport, TN 37660

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health and more.Insurance ›

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JOHN EVERETT TANNER DDS

Dentist (General Practice)

2701 BLOOMINGDALE RD
KINGSPORT, TN 37660

Sullivan County (423) 288-8566

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jordan Broadwater's NPI number?

The NPI number for Jordan Broadwater is 1164317020. It was assigned to this individual provider in the NPPES registry on June 11, 2025.

Where is Jordan Broadwater located?

Jordan Broadwater practices at 2701 Bloomingdale Rd, Kingsport, TN 37660. The listed phone number is (423) 288-8566.

What is Jordan Broadwater's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

What insurance does Jordan Broadwater accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of North Carolina and 11 other insurers list Jordan Broadwater as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jordan Broadwater was last updated on June 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.