MEDICARE: DR. WYATT STEPHEN JONES DDS

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	122300000X	Dentist	4954	ME

General Provider Information

NPI Number	:	1497484646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WYATT STEPHEN JONES DDS

Provider Business Mailing Address
First Line	:	215 W SHORE RD
Second Line	:
City	:	SORRENTO
State	:	ME
Zip	:	04677-3201
Country	:	US
Telephone Number	:	918-931-0937
Fax Number	:

Provider Business Practice Location Address
First Line	:	271 MAIN ST
Second Line	:
City	:	MACHIAS
State	:	ME
Zip	:	04654-3606
Country	:	US
Telephone Number	:	207-255-8601
Fax Number	:

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

Provider Enumeration Date	:	06/05/2022
Last Update Date	:	06/05/2022

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