Provider Demographics
NPI:1962572131
Name:PIKE, JON ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:ALAN
Last Name:PIKE
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 1:1007 SUSHRUTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1144 OPAL COURT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:301-733-2500
Practice Address - Fax:301-733-9600
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24891223S0112X
MD1ZZ681223S0112X
PADS02201ZL1223S0112X
MD122681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
229044OtherTRIGOD
MDDF52OtherBCBS
WV0136374000Medicaid
T32360Medicare UPIN
229044OtherTRIGOD