Provider Demographics
NPI:1841642154
Name:MCNAIR, JONATHAN ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALEXANDER
Last Name:MCNAIR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 WOLFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1832
Mailing Address - Country:US
Mailing Address - Phone:228-219-9601
Mailing Address - Fax:
Practice Address - Street 1:2300 WOLFLIN AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1832
Practice Address - Country:US
Practice Address - Phone:806-381-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357841223P0221X
MS3884-16122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409187801Medicaid