Healthcare Provider Details

I. General information

NPI: 1285563577
Provider Name (Legal Business Name): BENJAMIN RICHARD JONES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 W OWEN K GARRIOTT RD STE A
ENID OK
73703-4611
US

IV. Provider business mailing address

5202 W OWEN K GARRIOTT RD STE A
ENID OK
73703-4611
US

V. Phone/Fax

Practice location:
  • Phone: 580-242-5862
  • Fax:
Mailing address:
  • Phone: 580-242-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8174
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: