Provider Demographics
NPI:1992845374
Name:JONES, KIP J (DDS)
Entity Type:Individual
Prefix:
First Name:KIP
Middle Name:J
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 1:1151 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4413
Mailing Address - Country:US
Mailing Address - Phone:801-546-3513
Mailing Address - Fax:801-546-4118
Practice Address - Street 1:1151 ROSEWOOD LN
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4413
Practice Address - Country:US
Practice Address - Phone:801-546-3513
Practice Address - Fax:801-546-4118
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT615579899231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT61557989923OtherSTATE LICENSE