Provider Demographics
NPI:1518379569
Name:JONES, JENNIFER IJEOMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:IJEOMA
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2833
Mailing Address - Country:US
Mailing Address - Phone:177-031-7958
Mailing Address - Fax:
Practice Address - Street 1:660 N CREEK DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2632
Practice Address - Country:US
Practice Address - Phone:855-944-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014012881122300000X
SC95281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist