Provider Demographics
NPI:1730192980
Name:ELMER, JONATHAN RAY (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RAY
Last Name:ELMER
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 1:5780 N CAREFREE CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-2795
Mailing Address - Country:US
Mailing Address - Phone:719-597-9737
Mailing Address - Fax:719-597-1420
Practice Address - Street 1:55 E. 2200 S.
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010
Practice Address - Country:US
Practice Address - Phone:801-295-5115
Practice Address - Fax:801-294-0829
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist