Provider Demographics
NPI:1992813182
Name:NASH, JONATHAN BECKET (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BECKET
Last Name:NASH
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 1:2517 17TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501
Mailing Address - Country:US
Mailing Address - Phone:208-746-1373
Mailing Address - Fax:208-746-9855
Practice Address - Street 1:2517 17TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501
Practice Address - Country:US
Practice Address - Phone:208-746-1373
Practice Address - Fax:208-746-9855
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
149960173OtherADA
ID000010011285OtherREGENCE BLUE SHIELD
ID6A242OtherBLUE CROSS
ID805043900Medicaid