Provider Demographics
NPI:1487861332
Name:JONES, GARY MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MARTIN
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 1:2520 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3992
Mailing Address - Country:US
Mailing Address - Phone:916-773-8200
Mailing Address - Fax:916-773-1443
Practice Address - Street 1:2520 DOUGLAS BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3992
Practice Address - Country:US
Practice Address - Phone:916-773-8200
Practice Address - Fax:916-773-1443
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice