Provider Demographics
NPI:1649479569
Name:FORD, JONATHAN HOAGLAND (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:HOAGLAND
Last Name:FORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16511 GOLDENWEST ST STE 107
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4484
Mailing Address - Country:US
Mailing Address - Phone:714-842-7431
Mailing Address - Fax:
Practice Address - Street 1:16511 GOLDENWEST ST STE 107
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-4484
Practice Address - Country:US
Practice Address - Phone:714-842-7431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55836122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist