Provider Demographics
NPI:1417976101
Name:JONES, NIKKI ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:ELAINE
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 1:2120 KELLER AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-4632
Mailing Address - Country:US
Mailing Address - Phone:704-392-9357
Mailing Address - Fax:
Practice Address - Street 1:2120 KELLER AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-4632
Practice Address - Country:US
Practice Address - Phone:704-392-9357
Practice Address - Fax:704-394-9098
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902EXMedicaid