MEDICARE: DR. JOHN P JONES JR. D.D.S.

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	DS3802	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0037078	OTHER	TN	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	792718	OTHER	TN	UNITED CONCORDIA

General Provider Information

NPI Number	:	1679561658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN P JONES JR. D.D.S.

Provider Business Mailing Address
First Line	:	3720 CUNNINGHAM RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-5303
Country	:	US
Telephone Number	:	865-922-7469
Fax Number	:	865-925-4692

Provider Business Practice Location Address
First Line	:	3720 CUNNINGHAM RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-5303
Country	:	US
Telephone Number	:	865-922-7469
Fax Number	:	865-925-4692

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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