Provider Demographics
NPI:1134202922
Name:INMAN, JON BRENT (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:BRENT
Last Name:INMAN
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 1:116 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47993-1149
Mailing Address - Country:US
Mailing Address - Phone:765-762-3755
Mailing Address - Fax:765-762-3756
Practice Address - Street 1:116 E 2ND ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:IN
Practice Address - Zip Code:47993-1149
Practice Address - Country:US
Practice Address - Phone:765-762-3755
Practice Address - Fax:765-762-3756
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008583A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice