Provider Demographics
NPI:1104192020
Name:STREET JONES, EDNA INEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:INEZ
Last Name:STREET JONES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MOUNTAIN GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2602
Mailing Address - Country:US
Mailing Address - Phone:410-493-6702
Mailing Address - Fax:
Practice Address - Street 1:2501 LIBERTY HEIGHTS AVE
Practice Address - Street 2:LSB 233
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-7922
Practice Address - Country:US
Practice Address - Phone:410-462-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2012-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist