Individual
DR. JONATHAN YRISARRI STATESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2940 STANLEY RD BLDG 2375, FORT SAM HOUSTON, TX 78234-2740
(210) 295-4156
Mailing address
2940 STANLEY RD BLDG 2375, FORT SAM HOUSTON, TX 78234-2740
(210) 295-4156
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
26564
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
26564
TX
Other
Enumeration date
08/16/2011
Last updated
07/07/2025
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