Provider Demographics
NPI:1578943163
Name:JONES DENTAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:JONES DENTAL MANAGEMENT, LLC
Other - Org Name:KAYSVILLE PEDIATRIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, CAGS
Authorized Official - Phone:801-544-3323
Mailing Address - Street 1:283 N 300 W
Mailing Address - Street 2:#501
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1879
Mailing Address - Country:US
Mailing Address - Phone:801-544-3323
Mailing Address - Fax:801-544-3327
Practice Address - Street 1:283 N 300 W
Practice Address - Street 2:#501
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1879
Practice Address - Country:US
Practice Address - Phone:801-544-3323
Practice Address - Fax:801-544-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6509903-9923122300000X, 1223P0221X, 1223X0400X
UT8173986122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty