Provider Demographics
NPI:1144388372
Name:JONES, KELLY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:NICOLE
Other - Last Name:MCNEIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9807 MCSARA CT.
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527
Mailing Address - Country:US
Mailing Address - Phone:251-626-9924
Mailing Address - Fax:251-626-9984
Practice Address - Street 1:9807 MCSARA CT.
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527
Practice Address - Country:US
Practice Address - Phone:251-626-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL55341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA812080119AMedicaid
GA9181143OtherDORAL MEDICAID
GA100200OtherAVESIS MEDICAID
AL102176Medicaid