Provider Demographics
NPI:1639187537
Name:JONES, MARK D (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8799 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2363
Mailing Address - Country:US
Mailing Address - Phone:330-394-7462
Mailing Address - Fax:330-394-3860
Practice Address - Street 1:8799 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2363
Practice Address - Country:US
Practice Address - Phone:330-394-7462
Practice Address - Fax:330-394-3860
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2029781Medicaid