Provider Demographics
NPI:1114162484
Name:DETWILER, JON P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:P
Last Name:DETWILER
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 1:1525 ELECTION HOUSE RD NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9059
Mailing Address - Country:US
Mailing Address - Phone:740-653-1031
Mailing Address - Fax:740-653-4895
Practice Address - Street 1:1525 ELECTION HOUSE RD NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9059
Practice Address - Country:US
Practice Address - Phone:740-653-1031
Practice Address - Fax:740-653-4895
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30011784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist