Provider Demographics
NPI:1962946004
Name:WEST, JONATHAN REAGAN (DDS, MS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:REAGAN
Last Name:WEST
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 FLOYD AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2472
Mailing Address - Country:US
Mailing Address - Phone:209-524-5515
Mailing Address - Fax:
Practice Address - Street 1:1236 FLOYD AVE STE C
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2472
Practice Address - Country:US
Practice Address - Phone:209-524-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2019-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist