Healthcare Provider Details

I. General information

NPI: 1346771656
Provider Name (Legal Business Name): JONATHAN MICHAEL PRICE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5735 MEEKER RD
GREENVILLE OH
45331-1180
US

IV. Provider business mailing address

5735 MEEKER RD
GREENVILLE OH
45331-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-9680
  • Fax: 937-548-2418
Mailing address:
  • Phone: 937-547-2326
  • Fax: 937-548-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025055
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: