Provider Demographics
NPI:1598021016
Name:ELMORE, JONATHAN CLINTON (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CLINTON
Last Name:ELMORE
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 1:10524 MOSS PARK RD STE 204-616
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5898
Mailing Address - Country:US
Mailing Address - Phone:678-480-9808
Mailing Address - Fax:
Practice Address - Street 1:12711 NARCOOSSEE RD BLDG B, #100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-4355
Practice Address - Country:US
Practice Address - Phone:407-627-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL242131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery