Provider Demographics
NPI:1043724610
Name:JONES, BARAK TROY (DDS)
Entity Type:Individual
Prefix:
First Name:BARAK
Middle Name:TROY
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 POINCIANA PL APT 110
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4823
Mailing Address - Country:US
Mailing Address - Phone:405-780-6140
Mailing Address - Fax:
Practice Address - Street 1:3090 TALON DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3279
Practice Address - Country:US
Practice Address - Phone:307-237-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-18
Last Update Date:2017-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14121223X0400X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223D0001XDental ProvidersDentistDental Public Health