Provider Demographics
NPI:1679358071
Name:JONES, AMANDA GAIL (RDH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:JONES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BRIAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2301
Mailing Address - Country:US
Mailing Address - Phone:304-951-9989
Mailing Address - Fax:
Practice Address - Street 1:2 BRIAR HILL RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2301
Practice Address - Country:US
Practice Address - Phone:304-951-9989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
WV2272124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist