Provider Demographics
NPI:1902886302
Name:JONES, MICHAEL R (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
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 407
Mailing Address - Street 2:300 N. MAIN
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-0407
Mailing Address - Country:US
Mailing Address - Phone:785-483-2411
Mailing Address - Fax:785-483-2409
Practice Address - Street 1:300 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2731
Practice Address - Country:US
Practice Address - Phone:785-483-2411
Practice Address - Fax:785-483-2409
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS62831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice