Healthcare Provider Details

I. General information

NPI: 1245808468
Provider Name (Legal Business Name): VONTRISKA RONIQUE JONES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 MACGREGOR DOWNS RD
GREENVILLE NC
27834-5925
US

IV. Provider business mailing address

1916 SKIBO RD STE C3
FAYETTEVILLE NC
28314-1500
US

V. Phone/Fax

Practice location:
  • Phone: 910-814-4191
  • Fax:
Mailing address:
  • Phone: 910-484-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12369
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: