Provider Demographics
NPI:1215596051
Name:TRASKA, JONATHON (DDS)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:
Last Name:TRASKA
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 1:13200 W GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-3128
Mailing Address - Country:US
Mailing Address - Phone:262-510-7245
Mailing Address - Fax:
Practice Address - Street 1:S63W13660 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-2713
Practice Address - Country:US
Practice Address - Phone:414-425-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002091-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist