Provider Demographics
NPI:1871963090
Name:RUMINSON, JONATHAN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:RUMINSON
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 1:5913 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7832
Mailing Address - Country:US
Mailing Address - Phone:423-910-9778
Mailing Address - Fax:
Practice Address - Street 1:5913 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7832
Practice Address - Country:US
Practice Address - Phone:423-910-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist