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General NPI Number Information
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NPI Number | 1366950594
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Entity Type | Individual
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Provider Name | JONATHAN DANIEL CHODROFF DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 14411 NE 20TH AVE STE 101
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City | VANCOUVER
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State | WA
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Zip | 98686-6432
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Country | US
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Telephone | 360-425-7220
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Fax |
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Provider Business Mailing Address
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Address Line | 14411 NE 20TH AVE STE 101
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City | VANCOUVER
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State | WA
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Zip | 98686-6432
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Country | US
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Telephone | 360-425-7220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D10743
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 61358923
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License Number State | WA
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