Provider Demographics
NPI:1821247776
Name:ROSCOE, JONATHAN P (DMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:ROSCOE
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 1:1494A S ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-3832
Mailing Address - Country:US
Mailing Address - Phone:330-479-3225
Mailing Address - Fax:330-478-4781
Practice Address - Street 1:1494A S ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3832
Practice Address - Country:US
Practice Address - Phone:330-479-3225
Practice Address - Fax:330-478-4781
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist