=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972864346
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY KAYE JONES D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2012
-----------------------------------------------------
Last Update Date | 06/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4521 ATLANTIC BLVD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-1137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-398-7081
-----------------------------------------------------
Fax | 904-398-8003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4521 ATLANTIC BLVD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32207-1137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-398-7081
-----------------------------------------------------
Fax | 904-398-8003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 12783
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------