Provider Demographics
NPI:1255359113
Name:JONES, AUDRA Y (DDS)
Entity type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:Y
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 1:1805 MONUMENT AVE
Mailing Address - Street 2:STE 501
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220
Mailing Address - Country:US
Mailing Address - Phone:804-353-3009
Mailing Address - Fax:804-358-3159
Practice Address - Street 1:1805 MONUMENT AVE
Practice Address - Street 2:STE 501
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220
Practice Address - Country:US
Practice Address - Phone:804-353-3009
Practice Address - Fax:804-358-3159
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014100461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice