Healthcare Provider Details

I. General information

NPI: 1215465760
Provider Name (Legal Business Name): JONATHAN J. ARAGON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3472 STATE HIGHWAY 47
LOS LUNAS NM
87031-8222
US

IV. Provider business mailing address

54 ENTRADA ARAGON RD
LOS LUNAS NM
87031-7609
US

V. Phone/Fax

Practice location:
  • Phone: 505-435-9461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4691
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: