Provider Demographics
NPI:1316382112
Name:KONZ, JONATHON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHON
Middle Name:
Last Name:KONZ
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 1:42395 RYAN RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4864
Mailing Address - Country:US
Mailing Address - Phone:703-687-1581
Mailing Address - Fax:703-687-1583
Practice Address - Street 1:42395 RYAN RD STE 108
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-4864
Practice Address - Country:US
Practice Address - Phone:703-687-1581
Practice Address - Fax:703-687-1583
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD102461223P0221X
390200000X
VA04014150881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program