Provider Demographics
NPI:1952372054
Name:JONES, GARY HUGH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:HUGH
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 1:101 E LEHIGH AVE
Mailing Address - Street 2:PM2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1011
Mailing Address - Country:US
Mailing Address - Phone:215-707-3613
Mailing Address - Fax:215-707-5405
Practice Address - Street 1:101 E LEHIGH AVE
Practice Address - Street 2:PM2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1011
Practice Address - Country:US
Practice Address - Phone:215-707-3613
Practice Address - Fax:215-707-5405
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019871L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0048317000OtherIBC - KHPE
PA3254OtherAETNA MEDICAL
PA000097200OtherIBC PERSONAL CHOICE
PAJ97200OtherAMERIHEALTH ADMINISTRATOR
PAJ97200OtherAMERIHEALTH ADMINISTRATOR
PAT28527Medicare UPIN