Healthcare Provider Details

I. General information

NPI: 1174949374
Provider Name (Legal Business Name): RICHARD SCOTT JONES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N SULLIVAN RD STE 120
SPOKANE VALLEY WA
99037
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX 357134 UW DEPARTMENT OF ORAL SURGERY
SEATTLE WA
98195
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDE60830772
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDR60468262
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: