Healthcare Provider Details

I. General information

NPI: 1972095867
Provider Name (Legal Business Name): MICHAEL R. JONES, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MAIN ST
RUSSELL KS
67665-2731
US

IV. Provider business mailing address

300 N MAIN ST
RUSSELL KS
67665-2731
US

V. Phone/Fax

Practice location:
  • Phone: 785-483-2411
  • Fax: 785-483-2409
Mailing address:
  • Phone: 785-483-2411
  • Fax: 785-483-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number6283
License Number StateKS

VIII. Authorized Official

Name: DR. MICHAEL ROBERT JONES
Title or Position: PRESIDENT
Credential: DDS
Phone: 785-483-2411