Provider Demographics
NPI:1205276227
Name:JONES, RICHARD SHEPHERD (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SHEPHERD
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 1:239 NORTHERN BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411
Mailing Address - Country:US
Mailing Address - Phone:570-586-8900
Mailing Address - Fax:570-586-8912
Practice Address - Street 1:239 NORTHERN BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411
Practice Address - Country:US
Practice Address - Phone:570-586-8900
Practice Address - Fax:570-586-8912
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016731L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics