Healthcare Provider Details

I. General information

NPI: 1811564909
Provider Name (Legal Business Name): JONATHAN H FORD DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 WARNER AVE STE 101
HUNTINGTON BEACH CA
92649-6040
US

IV. Provider business mailing address

5355 WARNER AVE STE 101
HUNTINGTON BEACH CA
92649-6040
US

V. Phone/Fax

Practice location:
  • Phone: 714-409-6161
  • Fax: 714-841-7148
Mailing address:
  • Phone: 714-409-6161
  • Fax: 714-841-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN FORD
Title or Position: OWNER
Credential: DMD
Phone: 714-842-7431