MEDICARE: DR. KENNETH MAUGHAN JONES D.M.D.

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	122300000X	Dentist	D6990	OR

General Provider Information

NPI Number	:	1316945041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH MAUGHAN JONES D.M.D.

Provider Business Mailing Address
First Line	:	2233 WILLAMETTE ST E
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-2890
Country	:	US
Telephone Number	:	541-653-9739
Fax Number	:	541-743-2023

Provider Business Practice Location Address
First Line	:	2233 WILLAMETTE ST
Second Line	:	BLDG E
City	:	EUGENE
State	:	OR
Zip	:	97405-2890
Country	:	US
Telephone Number	:	541-687-4867
Fax Number	:	541-686-9620

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/08/2015

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