Provider Demographics
NPI:1356312318
Name:DUKES, JONATHAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:P
Last Name:DUKES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 WILDWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1814
Mailing Address - Country:US
Mailing Address - Phone:410-566-8042
Mailing Address - Fax:410-566-8899
Practice Address - Street 1:802 WILDWOOD PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1814
Practice Address - Country:US
Practice Address - Phone:410-566-8042
Practice Address - Fax:410-566-8899
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD125561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice