Provider Demographics
NPI:1255608725
Name:JONES, MARTIN LELAND (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LELAND
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 1:145 WATSON WAY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7582
Mailing Address - Country:US
Mailing Address - Phone:231-818-9384
Mailing Address - Fax:
Practice Address - Street 1:145 WATSON WAY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7582
Practice Address - Country:US
Practice Address - Phone:231-818-9384
Practice Address - Fax:614-436-6055
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0166421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0057574Medicaid