Provider Demographics
NPI:1609597061
Name:JONES, MAI (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAI
Middle Name:
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 1:12745 SW 172ND TER APT 2-103
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-2083
Mailing Address - Country:US
Mailing Address - Phone:503-929-7987
Mailing Address - Fax:
Practice Address - Street 1:2275 NE 27TH ST STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2352
Practice Address - Country:US
Practice Address - Phone:971-338-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist