Provider Demographics
NPI:1780661363
Name:JONES, GARRY D (DDS)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:D
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 1:10143 REDEYE CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5221
Mailing Address - Country:US
Mailing Address - Phone:714-963-7479
Mailing Address - Fax:
Practice Address - Street 1:18627 BROOKHURST ST
Practice Address - Street 2:#360
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6748
Practice Address - Country:US
Practice Address - Phone:714-267-3643
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist