Provider Demographics
NPI:1447538178
Name:PO, JONATHAN (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 N TEXAS ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1649
Mailing Address - Country:US
Mailing Address - Phone:707-422-5441
Mailing Address - Fax:
Practice Address - Street 1:2560 N TEXAS ST
Practice Address - Street 2:SUITE H
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1649
Practice Address - Country:US
Practice Address - Phone:707-422-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA618141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice