Provider Demographics
NPI:1477612331
Name:JONES, RICHARD T (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:JONES
Suffix:
Gender:M
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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:LUSK
Mailing Address - State:WY
Mailing Address - Zip Code:82225-0105
Mailing Address - Country:US
Mailing Address - Phone:307-334-9933
Mailing Address - Fax:
Practice Address - Street 1:911 S BALLANCEE AVE
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-0105
Practice Address - Country:US
Practice Address - Phone:307-334-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice