Provider Demographics
NPI:1396952297
Name:DEJONG, JONATHAN R (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:DEJONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 KENYON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5746
Mailing Address - Country:US
Mailing Address - Phone:515-576-8727
Mailing Address - Fax:515-576-7076
Practice Address - Street 1:804 KENYON RD STE 120
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5746
Practice Address - Country:US
Practice Address - Phone:515-576-8727
Practice Address - Fax:515-576-7076
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2010-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA084281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery