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General NPI Number Information
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NPI Number | 1629327051
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Entity Type | Individual
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Provider Name | JONATHAN BLAZE NEGRON DMD
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Gender | Male
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | NAVAL MEDICAL CENTER PORTSMOUTH 620 JOHN PAUL JONES CIRCLE
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City | PORTSMOUTH
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State | VA
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Zip | 23708
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Country | US
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Telephone | 757-953-7550
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Fax | 757-953-7560
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Provider Business Mailing Address
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Address Line | 5801 NICHOLSON LN APT 1414
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City | NORTH BETHESDA
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State | MD
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Zip | 20852
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Country | US
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Telephone | 772-579-2846
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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 | 15192
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License Number State | MD
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