Provider Demographics
NPI:1487832960
Name:JOHNATHAN P. EARP, DDS, PA
Entity type:Organization
Organization Name:JOHNATHAN P. EARP, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNATHAN
Authorized Official - Middle Name:POU
Authorized Official - Last Name:EARP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-756-3313
Mailing Address - Street 1:2401 S CHARLES BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858
Mailing Address - Country:US
Mailing Address - Phone:252-756-3313
Mailing Address - Fax:252-756-0146
Practice Address - Street 1:2401 S CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-756-3313
Practice Address - Fax:252-756-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7513261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental