Provider Demographics
NPI:1841559242
Name:JONES, JUDITH GOSS (RDH)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:GOSS
Last Name:JONES
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:JUDITH
Other - Middle Name:JONES
Other - Last Name:THETFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-729-8942
Mailing Address - Fax:
Practice Address - Street 1:407 EAST AVE
Practice Address - Street 2:MONTELLO ELEMENTARY SCHOOL
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-4776
Practice Address - Country:US
Practice Address - Phone:207-795-4150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3082124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist