MEDICARE: MICHAEL R. 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	261QD0000X	Dental Clinic/Center	6283	KS

General Provider Information

NPI Number	:	1972095867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL R. JONES, DDS, PA

Provider Business Mailing Address
First Line	:	300 N MAIN ST
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665-2731
Country	:	US
Telephone Number	:	785-483-2411
Fax Number	:	785-483-2409

Provider Business Practice Location Address
First Line	:	300 N MAIN ST
Second Line	:
City	:	RUSSELL
State	:	KS
Zip	:	67665-2731
Country	:	US
Telephone Number	:	785-483-2411
Fax Number	:	785-483-2409

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL ROBERT JONES
Credential	:	DDS
Telephone Number	:	785-483-2411

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	06/05/2018

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