MEDICARE: DR. DWIGHT WILEY JONES DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN11622	FL

General Provider Information

NPI Number	:	1053475863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT WILEY JONES DMD

Provider Business Mailing Address
First Line	:	6514 SAN JUAN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2858
Country	:	US
Telephone Number	:	904-786-5221
Fax Number	:

Provider Business Practice Location Address
First Line	:	6514 SAN JUAN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-2858
Country	:	US
Telephone Number	:	904-786-5221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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