Individual
DR. JONATHAN PATRICK BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2700 QUARRY LAKE DR STE 190, BALTIMORE, MD 21209-3743
(410) 484-4401
Mailing address
1220 CARAWAY CT STE 1050, UPPER MARLBORO, MD 20774-5338
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
15309
MD
1223P0221X
Pediatric Dentistry
15309
MD
Other
Enumeration date
06/20/2013
Last updated
10/09/2019
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