Provider Demographics
NPI:1700182482
Name:TAGLIARENI, JONATHAN MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:MICHAEL
Last Name:TAGLIARENI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6355
Mailing Address - Fax:570-271-5788
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2769
Practice Address - Country:US
Practice Address - Phone:570-271-6355
Practice Address - Fax:570-271-5788
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0450571223S0112X
SC94791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX9479Medicaid