Provider Demographics
NPI:1336177153
Name:JONES, WAVERLY SHEPARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAVERLY
Middle Name:SHEPARD
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 1:45 LUDLOW ST
Mailing Address - Street 2:STE 520
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1950
Mailing Address - Country:US
Mailing Address - Phone:914-968-7822
Mailing Address - Fax:914-968-7897
Practice Address - Street 1:45 LUDLOW ST
Practice Address - Street 2:STE 520
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1950
Practice Address - Country:US
Practice Address - Phone:914-968-7822
Practice Address - Fax:914-968-7897
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0.0701122300000X
CA53420122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist