Provider Demographics
NPI:1871716167
Name:ARMSTRONG, JON RANDALL (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:RANDALL
Last Name:ARMSTRONG
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 1:624 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1936
Mailing Address - Country:US
Mailing Address - Phone:608-558-1417
Mailing Address - Fax:
Practice Address - Street 1:528 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-2817
Practice Address - Country:US
Practice Address - Phone:412-343-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49861223G0001X
PADS443521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice