Provider Demographics
NPI:1790807949
Name:JONES, MERWIN RUSSELL III (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERWIN
Middle Name:RUSSELL
Last Name:JONES
Suffix:III
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 1:2696 BALL RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140
Mailing Address - Country:US
Mailing Address - Phone:513-677-9682
Mailing Address - Fax:
Practice Address - Street 1:6782 GOSHEN ROAD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122
Practice Address - Country:US
Practice Address - Phone:513-722-2933
Practice Address - Fax:513-722-2923
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300153111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0389753Medicaid