Provider Demographics
NPI:1184091456
Name:BRADLEY H JONNES DDS PLLC
Entity type:Organization
Organization Name:BRADLEY H JONNES DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:HO
Authorized Official - Last Name:JONNES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-681-4734
Mailing Address - Street 1:19718 68TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5965
Mailing Address - Country:US
Mailing Address - Phone:425-778-2126
Mailing Address - Fax:
Practice Address - Street 1:19718 68TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5965
Practice Address - Country:US
Practice Address - Phone:425-778-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60292953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty