Provider Demographics
NPI:1265828131
Name:JONKE, DAVID THOMAS (DDS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:THOMAS
Last Name:JONKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:THOMAS
Other - Last Name:JONKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:15640 MADISON AVE.
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD,
Mailing Address - State:OH
Mailing Address - Zip Code:44107
Mailing Address - Country:US
Mailing Address - Phone:216-228-1012
Mailing Address - Fax:
Practice Address - Street 1:15640 MADISON AVE.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD,
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-228-1012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist