MEDICARE: JONATHAN H FORD DDS INC

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	332BC3200X	Customized Equipment (DME)
2	122300000X	Dentist

General Provider Information

NPI Number	:	1811564909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN H FORD DDS INC

Provider Business Mailing Address
First Line	:	5355 WARNER AVE STE 101
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-6040
Country	:	US
Telephone Number	:	714-409-6161
Fax Number	:	714-841-7148

Provider Business Practice Location Address
First Line	:	5355 WARNER AVE STE 101
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-6040
Country	:	US
Telephone Number	:	714-409-6161
Fax Number	:	714-841-7148

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN FORD
Credential	:	DMD
Telephone Number	:	714-842-7431

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	01/29/2024

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