Provider Demographics
NPI:1396757126
Name:PARKER, JONATHAN ARTHUR (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ARTHUR
Last Name:PARKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7225 OHMS LN
Mailing Address - Street 2:SUITE 180
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2171
Mailing Address - Country:US
Mailing Address - Phone:952-345-0290
Mailing Address - Fax:952-920-0105
Practice Address - Street 1:7225 OHMS LN
Practice Address - Street 2:SUITE 180
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2171
Practice Address - Country:US
Practice Address - Phone:952-345-0290
Practice Address - Fax:952-920-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN95031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39984Medicare UPIN