Provider Demographics
NPI:1932104825
Name:HONGO, JONNA ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONNA
Middle Name:ELIZABETH
Last Name:HONGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 SE HAWTHORNE BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3170
Mailing Address - Country:US
Mailing Address - Phone:503-656-8966
Mailing Address - Fax:503-238-7022
Practice Address - Street 1:4511 SE HAWTHORNE BLVD
Practice Address - Street 2:STE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-3170
Practice Address - Country:US
Practice Address - Phone:503-656-8966
Practice Address - Fax:503-238-7022
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR59841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice