Provider Demographics
NPI:1689840100
Name:JONES, MICHAEL GLADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GLADE
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WHITNEY RANCH RD
Mailing Address - Street 2:SUITE D 18
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:702-435-9966
Mailing Address - Fax:702-435-0849
Practice Address - Street 1:601 WHITNEY RANCH RD
Practice Address - Street 2:SUITE D 18
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-435-9966
Practice Address - Fax:702-435-0849
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist