# JONATHAN CHODROFF, MD, DDS, II, P.L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake River Oral and Facial Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497547517
- **Authorized official:** DR. JONATHAN DANIEL CHODROFF DDS, MD (ORAL SURGEON)
- **Authorized official phone:** (302) 379-3104

## Contact information

- **Practice address:** 14411 NE 20TH AVE STE 111, VANCOUVER, WA 98686-6433
- **Practice address phone:** (360) 425-7220
- **Mailing address:** 14411 NE 20TH AVE STE 111, VANCOUVER, WA 98686-6433
- **Mailing address phone:** (360) 425-7220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2025
- **Last updated:** 05/22/2025