Provider Demographics
NPI:1912104464
Name:JONES, JUSTIN B (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:B
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:PO BOX 2039
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75710-2039
Mailing Address - Country:US
Mailing Address - Phone:903-535-0023
Mailing Address - Fax:903-535-0052
Practice Address - Street 1:132 S HORACE AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-6159
Practice Address - Country:US
Practice Address - Phone:903-526-4900
Practice Address - Fax:903-526-4907
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233061223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23306OtherDENTAL LICENSE