Provider Demographics
NPI:1962551093
Name:WALDRON, JONATHAN CHARLES (DMD PC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CHARLES
Last Name:WALDRON
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 DAVENPORT CIR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4213
Mailing Address - Country:US
Mailing Address - Phone:678-354-4009
Mailing Address - Fax:770-509-2326
Practice Address - Street 1:3020 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4996
Practice Address - Country:US
Practice Address - Phone:770-977-5547
Practice Address - Fax:770-509-2326
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist