Provider Demographics
NPI:1275063117
Name:JONES, STEPHANIE DIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DIAN
Last Name: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 1:7411 WINEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3736
Mailing Address - Country:US
Mailing Address - Phone:432-528-8626
Mailing Address - Fax:
Practice Address - Street 1:1460 EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5216
Practice Address - Country:US
Practice Address - Phone:830-372-2949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice