Provider Demographics
NPI:1518025584
Name:JONES, GALE FRAZIER (DDS)
Entity Type:Individual
Prefix:DR
First Name:GALE
Middle Name:FRAZIER
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 1:5251 S LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-4437
Mailing Address - Country:US
Mailing Address - Phone:804-222-4003
Mailing Address - Fax:804-222-2553
Practice Address - Street 1:5251 S LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-4437
Practice Address - Country:US
Practice Address - Phone:804-222-4003
Practice Address - Fax:804-222-2553
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA040100071281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9183514Medicaid