Provider Demographics
NPI:1134350507
Name:RHOADES, JONATHAN JAMES (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMES
Last Name:RHOADES
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 DOCTORS PARK
Mailing Address - Street 2:REAR SUITE
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703
Mailing Address - Country:US
Mailing Address - Phone:207-576-9768
Mailing Address - Fax:
Practice Address - Street 1:53 DOCTORS PARK
Practice Address - Street 2:REAR SUITE
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703
Practice Address - Country:US
Practice Address - Phone:207-576-9768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080066341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics