Provider Demographics
NPI:1013201300
Name:NASH, JONATHAN P (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:P
Last Name:NASH
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2938
Mailing Address - Country:US
Mailing Address - Phone:218-722-0823
Mailing Address - Fax:218-722-7635
Practice Address - Street 1:2860 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2938
Practice Address - Country:US
Practice Address - Phone:218-722-0823
Practice Address - Fax:218-722-7635
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist