Provider Demographics
NPI:1518711332
Name:JONES, KEISHA MEASHALL (RDH)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:MEASHALL
Last Name:JONES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KEISHA
Other - Middle Name:MEASHALL
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:12713 WOOD LILLY TRL
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-6017
Mailing Address - Country:US
Mailing Address - Phone:512-699-7301
Mailing Address - Fax:
Practice Address - Street 1:605 OLD AUSTIN HWY
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5034
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14641124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist