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General NPI Number Information
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NPI Number | 1477323095
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Entity Type | Individual
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Provider Name | JONATHAN GERALD MAINS DMD
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Gender | Male
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Dates
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Enumeration Date | 01/04/2024
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 100 OAKWOOD AVE STE 200
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City | STATE COLLEGE
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State | PA
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Zip | 16803-2636
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Country | US
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Telephone | 814-237-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 106 ROBIN ST
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City | CAIRNBROOK
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State | PA
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Zip | 15924-8609
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Country | US
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Telephone | 785-802-9896
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS044452
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License Number State | PA
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