Jonathan J Kolon, DDS
Individual provider Active NPI General Practice Dentistry · Santa Clara, UT
NPI 1225239171 · NPPES record last updated Sep 28, 2020
Key facts
- NPI
- 1225239171
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4994088 (UT)
- Practice address
- 3176 Santa Clara Drive
Santa Clara, UT 84765 - Phone
- (435) 615-6819
- Fax
- (435) 658-0041
- NPI assigned
- May 29, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210712000018 | UT | Order and Referring Only - Dentist |
6103228309 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4994088 | UT | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4994088 | UT | Yes |
Addresses
Primary practice location
3176 Santa Clara Drive
Santa Clara, UT 84765
Mailing address
3176 Santa Clara Dr
Santa Clara, UT 84765-5338
Phone (435) 615-6819
Other practice location 1
Naval Medicasl Center Portsmouth
Portsmouth, VA 23708
Phone (757) 959-2711
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201588686 | Other | UT | FEIN |
Other providers in Santa Clara, UT
- Innovative Neontal Solutions LLC
- Intermountain Healthcare
- Jay Redd DMD PC
- Nicholas Jensen
- Elizabeth Ann Johnson
- Paul Martz
- Nathan Seth Moore
- Chelsie Renee Newkirk
- Whittnee Kulanakea Nihipali
- Kevin Okeefe
All providers in Santa Clara, UT · General Practice Dentistry in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.