MEDICARE: DR. ROBERT MICHAEL JONES D.D.S.

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	1223P0300X	Periodontics	34620	CA

General Provider Information

NPI Number	:	1346309176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MICHAEL JONES D.D.S.

Provider Business Mailing Address
First Line	:	2118 WILSHIRE BLVD # 256
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5704
Country	:	US
Telephone Number	:	805-498-6631
Fax Number	:

Provider Business Practice Location Address
First Line	:	2904 THERESA DR
Second Line	:	SUITE 1
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-3137
Country	:	US
Telephone Number	:	805-498-6631
Fax Number	:	805-498-6508

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

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	02/08/2017

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