Provider Demographics
NPI:1093047771
Name:JONES, ROBERT SIMON (DDS PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SIMON
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:515 DELAWARE STREET SE
Mailing Address - Street 2:6-150 MOOS HEALTH SCIENCES
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-0395
Mailing Address - Fax:612-626-2900
Practice Address - Street 1:515 DELAWARE STREET SE
Practice Address - Street 2:6-150 MOOS HEALTH SCIENCES
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-0395
Practice Address - Fax:612-626-2900
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNFF44122300000X
CA51481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist