Healthcare Provider Details

I. General information

NPI: 1871716167
Provider Name (Legal Business Name): JON RANDALL ARMSTRONG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 WASHINGTON RD
MT LEBANON PA
15228-2817
US

IV. Provider business mailing address

624 30TH AVE
MONROE WI
53566-1936
US

V. Phone/Fax

Practice location:
  • Phone: 412-343-5422
  • Fax:
Mailing address:
  • Phone: 608-558-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4986
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS44352
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: