Healthcare Provider Details

I. General information

NPI: 1326100678
Provider Name (Legal Business Name): WILLIAM H JONES D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N KINGSHIGHWAY BLVD
SAINT LOUIS MO
63113-1408
US

IV. Provider business mailing address

1301 N KINGSHIGHWAY BLVD
SAINT LOUIS MO
63113-1408
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-1434
  • Fax: 314-367-2217
Mailing address:
  • Phone: 314-367-1434
  • Fax: 314-367-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number011292
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: