Provider Demographics
NPI:1518111632
Name:BLETSCHER, JON DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DANIEL
Last Name:BLETSCHER
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:PO BOX 357
Mailing Address - Street 2:1085 E. HARBOR
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-0357
Mailing Address - Country:US
Mailing Address - Phone:503-861-3707
Mailing Address - Fax:
Practice Address - Street 1:1085 E. HARBOR DR.
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-0357
Practice Address - Country:US
Practice Address - Phone:503-861-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR58371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice