Provider Demographics
NPI:1669519161
Name:JONES, ALAN WAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:WAYNE
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:PO BOX 5050
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:TN
Mailing Address - Zip Code:38257-0050
Mailing Address - Country:US
Mailing Address - Phone:270-472-1108
Mailing Address - Fax:270-472-6598
Practice Address - Street 1:309 MAIN ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:KY
Practice Address - Zip Code:42041-1603
Practice Address - Country:US
Practice Address - Phone:270-472-1108
Practice Address - Fax:270-472-6598
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice