Provider Demographics
NPI:1083350144
Name:VO, JOHNATHAN (DMD)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:
Last Name:VO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 S FIR CT
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1751
Mailing Address - Country:US
Mailing Address - Phone:918-938-9975
Mailing Address - Fax:
Practice Address - Street 1:5510 E 41ST ST STE C
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6037
Practice Address - Country:US
Practice Address - Phone:918-641-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK76411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice