MEDICARE: DR. JONATHAN YRISARRI STATESON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26564	TX
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	26564	TX

General Provider Information

NPI Number	:	1326327727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN YRISARRI STATESON DDS

Provider Business Mailing Address
First Line	:	2940 STANLEY RD BLDG 2375
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-2740
Country	:	US
Telephone Number	:	210-295-4156
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 STANLEY RD BLDG 2375
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-2740
Country	:	US
Telephone Number	:	210-295-4156
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	07/07/2025

Similar Medicare Providers

1114901261 — SCOTT VASSEL SCHLOFMAN DDS
Practice Location Address:

2940 STANLEY RD
FORT SAM HOUSTON, TX
78234-2740

Practice Phone: 210-295-4095
Practice Fax:

1215032057 — DR. ELLIOTT BERMUDEZ-COLON DDS
Practice Location Address:

2940 STANLEY RD STE 2375
FORT SAM HOUSTON, TX
78234-2740

Practice Phone: 210-295-4595
Practice Fax:

1750464525 — DR. CRAIG GLOVER PATTERSON DDS
Practice Location Address:

2940 STANLEY RD STE 2375
FORT SAM HOUSTON, TX
78234-2740

Practice Phone: 210-295-4095
Practice Fax: 210-295-5832

1316294804 — SEUNG HYUN HONG D.M.D
Practice Location Address:

2940 STANLEY RD
JBSA FT SAM HOUSTON, TX
78234-2740

Practice Phone: 808-754-9168
Practice Fax:

1609328152 — HOWARD FISHER JR.
Practice Location Address:

2940 STANLEY RD , SUITE 2375
FORT SAM HOUSTON, TX
78234-2740

Practice Phone: 210-295-5000
Practice Fax:

1821512765 — DR. ERIC JUSTIN TONG DDS
Practice Location Address:

2940 STANLEY RD BLDG 2375
FORT SAM HOUSTON, TX
78234-2740

Practice Phone: 210-295-4156
Practice Fax:

Directions to “ DR. JONATHAN YRISARRI STATESON DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.