Provider Demographics
NPI:1750464046
Name:LINER, JONATHAN DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DALE
Last Name:LINER
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 1:1690 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-7630
Mailing Address - Country:US
Mailing Address - Phone:336-838-9400
Mailing Address - Fax:336-838-1872
Practice Address - Street 1:1690 RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-7630
Practice Address - Country:US
Practice Address - Phone:336-838-9400
Practice Address - Fax:336-838-1872
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC841955OtherUNITED CONCORDIA
NC0154YOtherBCBS
NC790154YMedicaid