MEDICARE: DR. NEAL LEBARON 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D07633	AZ
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	019.027845	IL

General Provider Information

NPI Number	:	1386899573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEAL LEBARON JONES D.D.S.

Provider Business Mailing Address
First Line	:	4535 PASEO BRAZOS
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-2376
Country	:	US
Telephone Number	:	520-508-6575
Fax Number	:

Provider Business Practice Location Address
First Line	:	2107 PASEO SAN LUIS
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4563
Country	:	US
Telephone Number	:	520-732-8631
Fax Number	:

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

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	03/01/2013

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