Provider Demographics
NPI:1508971052
Name:JONES, BRENT ROBERT (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ROBERT
Last Name:JONES
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2348 IOWA STREET
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046
Mailing Address - Country:US
Mailing Address - Phone:785-842-5555
Mailing Address - Fax:785-749-1612
Practice Address - Street 1:2348 IOWA STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046
Practice Address - Country:US
Practice Address - Phone:785-842-5555
Practice Address - Fax:785-749-1612
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS70331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice