Provider Demographics
NPI:1184181232
Name:JONES, DEANDRA (DMD)
Entity Type:Individual
Prefix:
First Name:DEANDRA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 HERMITAGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1681
Mailing Address - Country:US
Mailing Address - Phone:901-826-9583
Mailing Address - Fax:
Practice Address - Street 1:520 HIGHWAY 76 STE 9
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188-8212
Practice Address - Country:US
Practice Address - Phone:615-672-7221
Practice Address - Fax:615-672-7211
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN115581223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry