=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073748083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN M. JONES, D.D.S.,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2009
-----------------------------------------------------
Last Update Date | 05/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1441 KAPIOLANI BLVD STE 907
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-955-0058
-----------------------------------------------------
Fax | 808-943-3423
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1441 KAPIOLANI BLVD STE 907
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96814-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-955-0058
-----------------------------------------------------
Fax | 808-943-3423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JOHN M. JONES
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 808-955-0058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 1082
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------