Provider Demographics
NPI:1922153303
Name:JONES, STACEY S (DDS,LLC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:S
Last Name:JONES
Suffix:
Gender:F
Credentials:DDS,LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 JIMMIE DAVIS HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4556
Mailing Address - Country:US
Mailing Address - Phone:318-742-0800
Mailing Address - Fax:318-742-0832
Practice Address - Street 1:1611 JIMMIE DAVIS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4556
Practice Address - Country:US
Practice Address - Phone:318-742-0800
Practice Address - Fax:318-742-0832
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice