Provider Demographics
NPI:1154053445
Name:PEYTON, JONATHAN RICHARD
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:PEYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 E BROOKLYN VILLAGE AVE APT 313
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3436
Mailing Address - Country:US
Mailing Address - Phone:980-808-7035
Mailing Address - Fax:
Practice Address - Street 1:CMC DENTAL CLINIC
Practice Address - Street 2:1000 BLYTHE BLVD
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-2165
Practice Address - Fax:704-355-8856
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0295122300000X, 125Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125Q00000XDental ProvidersDentistOral Medicine
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program