Individual
DR. JONATHAN FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
108 VILLAGE CENTER DR FL 2, FREEHOLD, NJ 07728-2510
(732) 780-2100
(732) 879-0255
Mailing address
108 VILLAGE CENTER DR FL 2, FREEHOLD, NJ 07728-2510
(732) 780-2100
(732) 879-0255
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI02429200
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/02/2009
Last updated
12/27/2018
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