Provider Demographics
NPI:1922488113
Name:JONES, JUSTIN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:A
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 1:1550 E MARYLAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1417
Mailing Address - Country:US
Mailing Address - Phone:602-285-9979
Mailing Address - Fax:602-265-5883
Practice Address - Street 1:1550 E MARYLAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1417
Practice Address - Country:US
Practice Address - Phone:602-285-9979
Practice Address - Fax:602-265-5883
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009253122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ021867Medicaid