Jonathan R Dejong, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

08428 Issued in IA

Practice address

804 Kenyon Rd Ste 120
Fort Dodge, IA 50501-5746

Phone

(515) 576-8727

Fax

(515) 576-7076

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2010 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: jdejong7653@uihcdirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fort Dodge Oral and Maxillofacial Surgery LLP

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Dodge, IA
  • NPI 1841324084
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276560000000",
    "number": "1396952297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 KENYON RD STE 120",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015746",
            "telephone_number": "515-576-8727",
            "fax_number": "515-576-7076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 KENYON RD STE 120",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015746",
            "telephone_number": "515-576-8727",
            "fax_number": "515-576-7076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJONG",
        "first_name": "JONATHAN",
        "middle_name": "R",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2010-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IA",
            "license": "08428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry R Davis, MD
• Patricia Day, RN
• Katie Ann Deal, LMHC
• Lori Degelau, LISW
• Ed Dehaan, MD
• Debra K Delp, RN
• Leopoldo E. Delucca, M.D.
• Kevin Lee Dencklau
• Desiree Dawn Diemer
• Disco Drug, Inc.

• Oral and Maxillofacial Surgery (Dentist) in Fort Dodge, IA
• Providers in Fort Dodge, IA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.