Provider Demographics
NPI:1992924997
Name:JONATHAN W PARKER DMD PA
Entity type:Organization
Organization Name:JONATHAN W PARKER DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-797-9669
Mailing Address - Street 1:38-27 FAIR LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4325
Mailing Address - Country:US
Mailing Address - Phone:201-797-9669
Mailing Address - Fax:201-797-0871
Practice Address - Street 1:38-27 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4325
Practice Address - Country:US
Practice Address - Phone:201-797-9669
Practice Address - Fax:201-797-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0121501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty