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General NPI Number Information
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NPI Number | 1154632271
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Entity Type | Organization
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Legal Business Name | JONES FAMILY & COSMETIC DENTISTRY
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 201 PAULINE DR. SUITE H
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City | BEREA
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State | KY
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Zip | 40403
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Country | US
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Telephone | 859-985-0201
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Fax | 859-985-0210
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Provider Business Mailing Address
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Address Line | P.O. BOX 1049
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City | BEREA
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State | KY
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Zip | 40403
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Country | US
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Telephone | 859-985-0201
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Fax | 859-985-0210
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MELISSA JANE JONES
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Credential |
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Telephone | 859-985-0201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8253
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License Number State | KY
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