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General NPI Number Information
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NPI Number | 1013395664
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Entity Type | Individual
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Provider Name | JONI JILL JONES RDH
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Gender | Female
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Dates
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Enumeration Date | 05/15/2015
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Last Update Date | 05/15/2015
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Provider Practice Location Address
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Address Line | 101 PAGOSA STREET
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-2336
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Country | US
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Telephone | 970-264-9436
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Fax | 970-264-9406
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Provider Business Mailing Address
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Address Line | PO BOX 2336
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-2336
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Country | US
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Telephone | 970-264-9436
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Fax | 970-264-9406
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 000905162
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License Number State | CO
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