Provider Demographics
NPI:1932363967
Name:JON'S DENTAL LABORATORY INC.
Entity Type:Organization
Organization Name:JON'S DENTAL LABORATORY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CERTIFIED DENTAL TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LITTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:CDT
Authorized Official - Phone:940-453-3904
Mailing Address - Street 1:111 ALAN A DALE CIR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-1302
Mailing Address - Country:US
Mailing Address - Phone:940-453-3904
Mailing Address - Fax:
Practice Address - Street 1:111 ALAN A DALE CIR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-1302
Practice Address - Country:US
Practice Address - Phone:940-453-3904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1294292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1294OtherTEXAS STATE BOARD OF DENTAL EXAMINERS