Provider Demographics
NPI:1861874638
Name:BOOKOUT, JONATHAN KEITH (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:KEITH
Last Name:BOOKOUT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 HIGH MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8103
Mailing Address - Country:US
Mailing Address - Phone:912-389-0638
Mailing Address - Fax:
Practice Address - Street 1:444 N BELAIR RD STE 101
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3002
Practice Address - Country:US
Practice Address - Phone:762-218-2186
Practice Address - Fax:762-200-2302
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist