Provider Demographics
NPI:1902188931
Name:JONES, ANTONIA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14707 CALIFORNIA ST
Mailing Address - Street 2:STE 8
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1933
Mailing Address - Country:US
Mailing Address - Phone:402-498-5800
Mailing Address - Fax:402-492-9031
Practice Address - Street 1:14707 CALIFORNIA ST
Practice Address - Street 2:STE 8
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1933
Practice Address - Country:US
Practice Address - Phone:402-218-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE73481223X0400X
VA04014127361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE82-0741925OtherEIN