Provider Demographics
NPI:1184251654
Name:VO, JONATHAN B
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:B
Last Name:VO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7519 LITTLE RIVER TPKE APT T-1
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2930
Mailing Address - Country:US
Mailing Address - Phone:571-299-0655
Mailing Address - Fax:
Practice Address - Street 1:7519 LITTLE RIVER TPKE APT T-1
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2930
Practice Address - Country:US
Practice Address - Phone:571-299-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401416778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist