Provider Demographics
NPI:1225239171
Name:KOLON, JONATHAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:J
Last Name:KOLON
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 1:3176 SANTA CLARA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5338
Mailing Address - Country:US
Mailing Address - Phone:435-615-6819
Mailing Address - Fax:
Practice Address - Street 1:3176 SANTA CLARA DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765
Practice Address - Country:US
Practice Address - Phone:435-615-6819
Practice Address - Fax:435-658-0041
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49940881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT201588686OtherFEIN