Provider Demographics
NPI:1871606830
Name:LAFOND, JONATHAN M (DMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:LAFOND
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 1:8602 ARTHUR HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7424
Mailing Address - Country:US
Mailing Address - Phone:843-760-0640
Mailing Address - Fax:
Practice Address - Street 1:455 OLD TROLLEY RD
Practice Address - Street 2:STE E
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5669
Practice Address - Country:US
Practice Address - Phone:843-851-0104
Practice Address - Fax:843-851-0210
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31701223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC970893OtherUNITED CONCORDIA
SCZ31706Medicaid
SC970893OtherUNITED CONCORDIA