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NPI Code Detail

MEDICARE: DR. JACKIE JONES III D.M.D.

MEDICARE: DR. JACKIE JONES III D.M.D.
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
11223G0001XGeneral Practice Dentistry3743-14MS

General Provider Information

NPI Number : 1902210297
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACKIE JONES III D.M.D.
Provider Business Mailing Address
First Line : 1040 HIGHWAY 35 S
Second Line :
City : FOREST
State : MS
Zip : 39074-9423
Country : US
Telephone Number : 601-469-3851
Fax Number : 601-469-4356
Provider Business Practice Location Address
First Line : 1040 HIGHWAY 35 S
Second Line :
City : FOREST
State : MS
Zip : 39074-9423
Country : US
Telephone Number : 601-469-3851
Fax Number : 601-469-4356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2014
Last Update Date : 06/16/2014

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