Provider Demographics
NPI:1932322898
Name:PREBLE, JONATHAN W (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:W
Last Name:PREBLE
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 1:499 E CENTRAL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3402
Mailing Address - Country:US
Mailing Address - Phone:407-831-3959
Mailing Address - Fax:407-831-0751
Practice Address - Street 1:499 E CENTRAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3402
Practice Address - Country:US
Practice Address - Phone:407-831-3959
Practice Address - Fax:407-831-0751
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00125401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice