Provider Demographics
NPI:1710982830
Name:ROXAS, JONATHAN VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:VINCENT
Last Name:ROXAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:V
Other - Last Name:ROXAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:6227 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2749
Mailing Address - Country:US
Mailing Address - Phone:503-777-1332
Mailing Address - Fax:360-777-9990
Practice Address - Street 1:6227 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-2749
Practice Address - Country:US
Practice Address - Phone:503-777-1332
Practice Address - Fax:360-777-9990
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD78271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice