Provider Demographics
NPI:1770869018
Name:JUDITH JONES DDS PLLC
Entity type:Organization
Organization Name:JUDITH JONES DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA-FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:956-682-1284
Mailing Address - Street 1:1801 S 5TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-2927
Mailing Address - Country:US
Mailing Address - Phone:956-682-1284
Mailing Address - Fax:956-687-8373
Practice Address - Street 1:1801 S 5TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2927
Practice Address - Country:US
Practice Address - Phone:956-682-1284
Practice Address - Fax:956-687-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164434106Medicaid
TX1588694301Medicaid