Provider Demographics
NPI:1386638096
Name:HAUN, JONATHAN LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LEE
Last Name:HAUN
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 1:238 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-4313
Mailing Address - Country:US
Mailing Address - Phone:571-330-6350
Mailing Address - Fax:
Practice Address - Street 1:901 M ST SE
Practice Address - Street 2:BLDG #166, BRANCH DENTAL CLINIC, WNY
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-0001
Practice Address - Country:US
Practice Address - Phone:202-433-2480
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD65921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics