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JONATHAN J PARK D.M.D.,M.D.
NPI 1114940905
Dentist - Oral and Maxillofacial Surgery in Fairfax, VA

Active since July 25, 2006Opted out of Medicare · through Apr 1, 2028
10530 ROSEHAVEN ST, SUITE 111, FAIRFAX, VA 22030(703) 385-5777(703) 591-5386 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jonathan J Park D.m.d.,m.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JONATHAN J PARK D.M.D.,M.D. (NPI 1114940905) is an individual oral and maxillofacial surgery provider in Fairfax, Virginia, licensed in Virginia (0101221324) and active in the NPI registry since July 2006. He has opted out of Medicare through April 1, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1114940905
Entity TypeIndividualMale
Primary Taxonomy1223S0112X
Provider Legal NameJONATHAN J PARKCredential: D.M.D.,M.D.
Location Address10530 ROSEHAVEN ST, SUITE 111Fairfax, VA 22030-2840
Mailing Address10530 Rosehaven St, Suite 111Fairfax, VA 22030-2840 · (703) 385-5777 · Fax (703) 591-5386
Phone(703) 385-5777
Fax(703) 591-5386
Sole ProprietorNo
Enumeration DateJuly 25, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1114940905 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers
Taxonomy Code1223S0112X
License✔ Licensed in VA · 0101221324
Definition
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
10530 ROSEHAVEN ST, Fairfax, VA 22030
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Florida Combined Life, HRI Dental & Vision and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Jonathan J Park D.m.d.,m.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from April 1, 2012 through April 1, 2028.

Opt-Out Effective DateApril 1, 2012
Opt-Out In Effect ThroughApril 1, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22030 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$100.31 typical visit price
range $65.18 – $194.86
Typical copayment $25.07 (range $16.29 – $48.71)
Most-billed visit code 99203
Established Patient
$80.66 typical visit price
range $21.40 – $158.88
Typical copayment $20.16 (range $5.35 – $39.72)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DINRAJ HEGDE MD
Family Medicine
10530 ROSEHAVEN ST
FAIRFAX, VA 22030
Fairfax City (703) 938-0363
HENRY W. ZUSSMAN D.D.S.
Dentist (Oral and Maxillofacial Surgery)
10530 ROSEHAVEN ST, SUITE 111
FAIRFAX, VA 22030
Fairfax City (703) 385-5777
JEFFREY A LANE D.D.S.
Dentist (Oral and Maxillofacial Surgery)
10530 ROSEHAVEN ST, SUITE 111
FAIRFAX, VA 22030
Fairfax City (703) 385-5777
FAIRFAX ORAL AND MAXILLOFACIAL SURGERY PC
Dentist (Oral and Maxillofacial Surgery)
10530 ROSEHAVEN ST, SUITE 111
FAIRFAX, VA 22030
Fairfax City (703) 385-5777
PATRICK J DOLAN D.D.S.
Dentist (Oral and Maxillofacial Surgery)
10530 ROSEHAVEN ST, SUITE 111
FAIRFAX, VA 22030
Fairfax City (703) 385-5777
KIMBERLY A SILLOWAY D.D.S.
Dentist (Oral and Maxillofacial Surgery)
10530 ROSEHAVEN ST, SUITE 111
FAIRFAX, VA 22030
Fairfax City (703) 385-5777
PETER W. SMITH D.D.S.
Dentist (Oral and Maxillofacial Surgery)
10530 ROSEHAVEN ST, SUITE 111
FAIRFAX, VA 22030
Fairfax City (703) 385-5777
DR. CYRUS A RAMSEY DMD MD
Dentist (Oral and Maxillofacial Surgery)
10530 ROSEHAVEN ST
FAIRFAX, VA 22030
Fairfax City (703) 385-5777

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jonathan Park's NPI number?

The NPI number for Jonathan Park is 1114940905. It was assigned to this individual provider in the NPPES registry on July 25, 2006.

Where is Jonathan Park located?

Jonathan Park practices at 10530 Rosehaven St Suite 111, Fairfax, VA 22030. The listed phone number is (703) 385-5777.

What is Jonathan Park's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Jonathan Park enrolled in Medicare?

No. Jonathan Park has opted out of Medicare through April 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Jonathan Park accept?

Health plans from BEST Life, Florida Combined Life, HRI Dental & Vision, Humana and Paramount and 2 other insurers list Jonathan Park as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jonathan Park was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.