Provider Demographics
NPI:1841383049
Name:MOCHNICK, JONATHAN CHRISTIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHRISTIAN
Last Name:MOCHNICK
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 1:1341 - B WESTGATE CENTER DR.
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3040
Mailing Address - Country:US
Mailing Address - Phone:336-765-3712
Mailing Address - Fax:336-760-0667
Practice Address - Street 1:1341 - B WESTGATE CENTER DR.
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3040
Practice Address - Country:US
Practice Address - Phone:336-765-3712
Practice Address - Fax:336-760-0667
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice