Provider Demographics
NPI:1508267899
Name:IRELAN, JON (DDS, MS, MS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:IRELAN
Suffix:
Gender:M
Credentials:DDS, MS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9556 SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8226
Mailing Address - Country:US
Mailing Address - Phone:503-715-6971
Mailing Address - Fax:
Practice Address - Street 1:7518 HWY 70 S STE B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1848
Practice Address - Country:US
Practice Address - Phone:615-669-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN114541223E0200X
WI7182-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics