DR. JONATHAN PATRICK BACON


Address: 2700 Quarry Lake Dr Ste 190, Baltimore, MD 21209-3743
Phone: 4104844401

DR. JONATHAN PATRICK BACON (NPI# 1811336142) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1811336142
Entity Type Individual
Full Name DR. JONATHAN PATRICK BACON
Credential D.D.S.
Practice Address 2700 Quarry Lake Dr Ste 190
Baltimore
MD 21209-3743
Mailing Address 1220 Caraway Ct Ste 1050
Upper Marlboro
MD 20774-5338
Practice Telephone 4104844401
Enumeration Date 2013-06-20
Last Update Date 2019-10-09
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 1223P0221X Dentist
Specialization: Pediatric Dentistry
15309 MD Dental Providers
Y 1223D0004X Dentist
Specialization: Dentist Anesthesiologist
15309 MD Dental Providers

Other Providers JONATHAN BACON

NPI Name Taxonomy Address Enumeration
1366506388 Jonathan P Bacon Orthopaedic Surgery 78 Dolphin Point Dr, Beaufort, SC 29907-1715 2006-12-21
1386924348 Jonathan Mark Bacon Pharmacist 1533 South Blvd, Charlotte, NC 28203-4723 2011-08-23

Office Location

Street Address 2700 QUARRY LAKE DR STE 190
City BALTIMORE
State MD
Zip Code 21209-3743

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Taxonomy Information

Taxonomy Code 1223D0004X
Grouping Dental Providers
Classification Dentist
Specialization Dentist Anesthesiologist

Taxonomy Definition

A dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation’s Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology.
Notes: Source: The American Society of Dentist Anesthesiologists [1/1/2013: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1457646218 Albert R Conley Dentist 7511 New Hampshire Ave, Takoma Park, MD 20912-6969 2011-06-09

Competitor

Search similar providers

City BALTIMORE
Zip Code 21209

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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