MEDICARE: DR. JACKIE S JONES DMD

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	1565	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740203504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKIE S JONES DMD

Provider Business Mailing Address
First Line	:	3700 S RUSSELL ST
Second Line	:	#116
City	:	MISSOULA
State	:	MT
Zip	:	59801-8574
Country	:	US
Telephone Number	:	406-542-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 S RUSSELL ST
Second Line	:	#116
City	:	MISSOULA
State	:	MT
Zip	:	59801-8574
Country	:	US
Telephone Number	:	406-542-3305
Fax Number	:

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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