Provider Demographics
NPI:1891711800
Name:JONES, BRIAN RAYMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RAYMOND
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 SW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1851
Mailing Address - Country:US
Mailing Address - Phone:541-889-2340
Mailing Address - Fax:
Practice Address - Street 1:2327 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1851
Practice Address - Country:US
Practice Address - Phone:541-889-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5931506-99221223G0001X
IDD-51551223G0001X
ORD112311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice