Provider Demographics
NPI:1295795011
Name:JONES, GARY OWEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:OWEN
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 1:1350 E MCKELLIPS RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2739
Mailing Address - Country:US
Mailing Address - Phone:480-834-3811
Mailing Address - Fax:480-969-8583
Practice Address - Street 1:1350 E MCKELLIPS RD
Practice Address - Street 2:SUITE #7
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2739
Practice Address - Country:US
Practice Address - Phone:480-834-3811
Practice Address - Fax:480-969-8583
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD33411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice