Provider Demographics
NPI:1205006103
Name:JONATHAN NASH, DDS PC
Entity type:Organization
Organization Name:JONATHAN NASH, DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-746-1373
Mailing Address - Street 1:2517 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6311
Mailing Address - Country:US
Mailing Address - Phone:208-746-1373
Mailing Address - Fax:208-746-9855
Practice Address - Street 1:2517 17TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6311
Practice Address - Country:US
Practice Address - Phone:208-746-1373
Practice Address - Fax:208-746-9855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTISTRY BY DESIGN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-06
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD32421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID149960173OtherADA
ID6A242OtherBLUE CROSS
ID805043900Medicaid
ID000010011285OtherREGENCE BLUE SHIELD
ID1992813182OtherNPI # INDIVIDUAL
ID9201666OtherIDAHO SMILES - DORAL