Provider Demographics
NPI:1710080528
Name:JONES, SHELLY FAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:FAY
Last Name:JONES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 N TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8841
Mailing Address - Country:US
Mailing Address - Phone:989-430-2816
Mailing Address - Fax:989-835-5656
Practice Address - Street 1:6118 MERLIN CT
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7358
Practice Address - Country:US
Practice Address - Phone:989-835-5665
Practice Address - Fax:989-835-5656
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010173331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710080528Medicaid