Provider Demographics
NPI:1700084423
Name:JONES, BRUCE D
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 JOSHUA LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2948
Mailing Address - Country:US
Mailing Address - Phone:760-365-8331
Mailing Address - Fax:
Practice Address - Street 1:7255 JOSHUA LN
Practice Address - Street 2:SUITE B
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2948
Practice Address - Country:US
Practice Address - Phone:760-365-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist