Provider Demographics
NPI:1033404157
Name:FU, JONATHAN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:FU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:MSC7892- ENDODONTICS
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-567-3321
Mailing Address - Fax:210-567-3389
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:MSC7892- ENDODONTICS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-3321
Practice Address - Fax:210-567-3389
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2527122300000X
TX29468122300000X
CA60617122300000X
NY055713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist