Provider Demographics
NPI:1093504821
Name:JONATHAN W. GANTZ, DDS PLLC
Entity type:Organization
Organization Name:JONATHAN W. GANTZ, DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-525-9111
Mailing Address - Street 1:2014 S. HOWARD ST STE D
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4532
Mailing Address - Country:US
Mailing Address - Phone:509-525-9111
Mailing Address - Fax:509-593-5155
Practice Address - Street 1:2014 S. HOWARD ST STE D
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4532
Practice Address - Country:US
Practice Address - Phone:509-525-9111
Practice Address - Fax:509-593-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental