Provider Demographics
NPI:1932515616
Name:COULON, JONATHAN (DDS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:COULON
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 1:3000 N GARFIELD ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-6400
Mailing Address - Country:US
Mailing Address - Phone:432-683-5313
Mailing Address - Fax:432-683-8195
Practice Address - Street 1:3000 N GARFIELD ST
Practice Address - Street 2:SUITE 220
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6400
Practice Address - Country:US
Practice Address - Phone:432-683-5313
Practice Address - Fax:432-683-8195
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice