Provider Demographics
NPI:1033116751
Name:JONES, GREGORY B (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
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 1:530 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2416
Mailing Address - Country:US
Mailing Address - Phone:541-567-1693
Mailing Address - Fax:541-567-2840
Practice Address - Street 1:530 SE 4TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2416
Practice Address - Country:US
Practice Address - Phone:541-567-1693
Practice Address - Fax:541-567-2840
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD69861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR077438Medicaid