Jonathan Park, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D010097 Issued in AZ

Practice address

7890 E Florentine Rd
Prescott Valley, AZ 86314-1204

Phone

(928) 770-5721

NPI assigned

Jul 10, 2018

Last updated

Jul 10, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531180800000",
    "number": "1023504297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21021 N 56TH ST APT 3086",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850545609",
            "telephone_number": "847-924-2485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7890 E FLORENTINE RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863141204",
            "telephone_number": "928-770-5721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-10",
        "last_updated": "2018-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Lara Ott, PT, MPT
• Bradley D Packer, O.D.
• Amanda Ann Paffumi, M.S. CCC-SLP
• Nancy Palazzi, RN
• Jordan Paluch
• Simon Park, DMD
• Lisa Marie Parsons, M.D.
• Nitin C Patel, M.D.
• Payal Patel
• Essie F Patterson, OTRL CHT

• General Practice Dentistry in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.