Provider Demographics
NPI:1790771806
Name:JONES, MARK S (DMD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:S
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:12661 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3400
Mailing Address - Country:US
Mailing Address - Phone:503-760-3214
Mailing Address - Fax:503-760-5586
Practice Address - Street 1:12661 SE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3400
Practice Address - Country:US
Practice Address - Phone:503-760-3214
Practice Address - Fax:503-760-5586
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist