Provider Demographics
NPI:1972235919
Name:JOURNETT, JONATHAN RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RAY
Last Name:JOURNETT
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 1:28095 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-3373
Mailing Address - Country:US
Mailing Address - Phone:301-884-8133
Mailing Address - Fax:
Practice Address - Street 1:28095 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3373
Practice Address - Country:US
Practice Address - Phone:301-884-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0401418042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program