Provider Demographics
NPI:1710644455
Name:JONES, JALISEYA DANAE (RDH)
Entity Type:Individual
Prefix:
First Name:JALISEYA
Middle Name:DANAE
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 1:1213 MAIN ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-4506
Mailing Address - Country:US
Mailing Address - Phone:832-220-1485
Mailing Address - Fax:
Practice Address - Street 1:1213 MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77506-4506
Practice Address - Country:US
Practice Address - Phone:832-220-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24549124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist