Provider Demographics
NPI:1639240849
Name:MCCALL, JONAS CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:
First Name:JONAS
Middle Name:CHRISTOPHER
Last Name:MCCALL
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 1:2214 CHANDLER ROAD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403
Mailing Address - Country:US
Mailing Address - Phone:918-686-6527
Mailing Address - Fax:918-682-4348
Practice Address - Street 1:2214 CHANDLER ROAD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403
Practice Address - Country:US
Practice Address - Phone:918-686-6527
Practice Address - Fax:918-682-4348
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK5672Medicaid
OKOK5672Medicaid