Provider Demographics
NPI:1952320681
Name:DACUS, JONATHAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:P
Last Name:DACUS
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 1:7522 HIGHWAY 107
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4645
Mailing Address - Country:US
Mailing Address - Phone:501-834-4800
Mailing Address - Fax:501-833-1414
Practice Address - Street 1:7522 HIGHWAY 107
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-4645
Practice Address - Country:US
Practice Address - Phone:501-834-4800
Practice Address - Fax:501-833-1414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58911OtherBLUE CROSS OF ARKANSAS
AR807159OtherUNITED CONCORDIA