Provider Demographics
NPI:1275141764
Name:PYLE, JONATHAN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:R
Last Name:PYLE
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 1:3931 MCREE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2628
Mailing Address - Country:US
Mailing Address - Phone:913-957-9967
Mailing Address - Fax:
Practice Address - Street 1:1642 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4601
Practice Address - Country:US
Practice Address - Phone:636-728-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020022768122300000X, 1223G0001X
IL019.032823122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist