MEDICARE: LANCE K JONES DDS PA

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1356697643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCE K JONES DDS PA

Provider Business Mailing Address
First Line	:	5754 LEONA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5363
Country	:	US
Telephone Number	:	214-739-5038
Fax Number	:

Provider Business Practice Location Address
First Line	:	5754 LEONA AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5363
Country	:	US
Telephone Number	:	214-739-5038
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LANCE JONES
Credential	:
Telephone Number	:	214-739-5030

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	07/24/2012

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