Healthcare Provider Details

I. General information

NPI: 1235134511
Provider Name (Legal Business Name): CRAIG RONALD JONOV DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 07/14/2006

III. Provider practice location address

509 OLIVE WAY STE 1454
SEATTLE WA
98101-1749
US

IV. Provider business mailing address

509 OLIVE WAY STE 1454
SEATTLE WA
98101-1749
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-0852
  • Fax: 206-622-2084
Mailing address:
  • Phone: 206-624-0852
  • Fax: 206-622-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number9246
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number43154
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: