Provider Demographics
NPI:1467671602
Name:MENIG, JON JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:JEFFREY
Last Name:MENIG
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 1:105 PROVIDENCE MINE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2950
Mailing Address - Country:US
Mailing Address - Phone:530-478-8366
Mailing Address - Fax:530-478-8370
Practice Address - Street 1:105 PROVIDENCE MINE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2950
Practice Address - Country:US
Practice Address - Phone:530-478-8366
Practice Address - Fax:530-478-8370
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA327441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics