MEDICARE: KEON JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN30057	FL

General Provider Information

NPI Number	:	1265135974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEON JONES

Provider Business Mailing Address
First Line	:	10317 CROSS CREEK BLVD STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2845
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10317 CROSS CREEK BLVD STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2845
Country	:	US
Telephone Number	:	813-706-4948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	01/26/2026

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