MEDICARE: H. DOUGLAS 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	122300000X	Dentist	026465	NY

General Provider Information

NPI Number	:	1831305549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	H. DOUGLAS JONES JR. D.D.S.

Provider Business Mailing Address
First Line	:	1552 EDGEMERE DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14612-1514
Country	:	US
Telephone Number	:	585-225-5496
Fax Number	:

Provider Business Practice Location Address
First Line	:	4415 BUFFALO RD
Second Line	:	STE. 10
City	:	NORTH CHILI
State	:	NY
Zip	:	14514-1024
Country	:	US
Telephone Number	:	585-594-4334
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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