Provider Demographics
NPI:1497547517
Name:JONATHAN CHODROFF, MD, DDS, II, P.L.L.C.
Entity type:Organization
Organization Name:JONATHAN CHODROFF, MD, DDS, II, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CHODROFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:302-379-3104
Mailing Address - Street 1:14411 NE 20TH AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-6433
Mailing Address - Country:US
Mailing Address - Phone:360-425-7220
Mailing Address - Fax:
Practice Address - Street 1:14411 NE 20TH AVE STE 111
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-6433
Practice Address - Country:US
Practice Address - Phone:360-425-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty