Provider Demographics
NPI:1154053445
Name:PEYTON, JONATHAN
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:PEYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 HARDING PL APT 239
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-0033
Mailing Address - Country:US
Mailing Address - Phone:980-808-7035
Mailing Address - Fax:
Practice Address - Street 1:CMC DENTAL CLINIC
Practice Address - Street 2:1000 BLYTHE BLVD
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-2165
Practice Address - Fax:704-355-8856
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program