Provider Demographics
NPI:1215158761
Name:PARKER, JONATHAN LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LEE
Last Name:PARKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 PARK AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2398
Mailing Address - Country:US
Mailing Address - Phone:949-494-3538
Mailing Address - Fax:949-494-5382
Practice Address - Street 1:330 PARK AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2398
Practice Address - Country:US
Practice Address - Phone:949-494-3538
Practice Address - Fax:949-494-5382
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice