Healthcare Provider Details

I. General information

NPI: 1295022564
Provider Name (Legal Business Name): ANNA R. JONES D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA R. BOONE

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 SOUTH BELT HIGHWAY
ST. JOSEPH MO
64503-1587
US

IV. Provider business mailing address

2911 SOUTH BELT HIGHWAY
ST. JOSEPH MO
64503-1587
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-6444
  • Fax: 816-364-6929
Mailing address:
  • Phone: 816-364-6444
  • Fax: 816-364-6929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2011014512
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: