Provider Demographics
NPI:1033735923
Name:PARKS, JOHNATHAN CARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:CARL
Last Name:PARKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 CACHE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-2710
Mailing Address - Country:US
Mailing Address - Phone:561-459-0947
Mailing Address - Fax:
Practice Address - Street 1:9430 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-8687
Practice Address - Country:US
Practice Address - Phone:866-929-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist