Provider Demographics
NPI:1891051991
Name:TIMOTHY J JONES DDS PC
Entity Type:Organization
Organization Name:TIMOTHY J JONES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-694-6154
Mailing Address - Street 1:1226 L ST
Mailing Address - Street 2:P O BOX 40
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-2047
Mailing Address - Country:US
Mailing Address - Phone:402-694-6154
Mailing Address - Fax:402-694-6155
Practice Address - Street 1:1226 L ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-2047
Practice Address - Country:US
Practice Address - Phone:402-694-6154
Practice Address - Fax:402-694-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025742800Medicaid