Provider Demographics
NPI:1295961860
Name:JONES, GREGGERY E (DMD)
Entity type:Individual
Prefix:
First Name:GREGGERY
Middle Name:E
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 1:54990 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-2409
Mailing Address - Country:US
Mailing Address - Phone:541-923-7633
Mailing Address - Fax:541-923-8733
Practice Address - Street 1:774 SW RIMROCK WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1941
Practice Address - Country:US
Practice Address - Phone:541-923-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD5188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist