Provider Demographics
NPI:1740313162
Name:ROYAL, JONOTHAN (DMD)
Entity type:Individual
Prefix:
First Name:JONOTHAN
Middle Name:
Last Name:ROYAL
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 1:9474 MOCKINGBIRD TRL
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-6354
Mailing Address - Country:US
Mailing Address - Phone:561-747-3403
Mailing Address - Fax:
Practice Address - Street 1:6390 W INDIANTOWN RD
Practice Address - Street 2:SUITE 32
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4607
Practice Address - Country:US
Practice Address - Phone:561-741-7142
Practice Address - Fax:561-741-7914
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist