Provider Demographics
NPI:1972864346
Name:JONES, MARY KAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY KAYE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-1137
Mailing Address - Country:US
Mailing Address - Phone:904-398-7081
Mailing Address - Fax:904-398-8003
Practice Address - Street 1:4521 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-1137
Practice Address - Country:US
Practice Address - Phone:904-398-7081
Practice Address - Fax:904-398-8003
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL127831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice