Provider Demographics
NPI:1932280427
Name:JONES, TODD KEVIN (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:KEVIN
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEAD
Mailing Address - State:SD
Mailing Address - Zip Code:57754-1644
Mailing Address - Country:US
Mailing Address - Phone:605-584-2983
Mailing Address - Fax:
Practice Address - Street 1:425 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEAD
Practice Address - State:SD
Practice Address - Zip Code:57754-1644
Practice Address - Country:US
Practice Address - Phone:605-584-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM4561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDM456OtherSTATE LICENSE #