Provider Demographics
NPI:1396725180
Name:KARDOS, JON PAUL (DDS)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:PAUL
Last Name:KARDOS
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:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 FLEMING DR
Practice Address - Street 2:
Practice Address - City:HARTS
Practice Address - State:WV
Practice Address - Zip Code:25524-9788
Practice Address - Country:US
Practice Address - Phone:304-855-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134442000Medicaid