Provider Demographics
NPI:1104963297
Name:JONES, OSMOND G (DDS, PC)
Entity type:Individual
Prefix:DR
First Name:OSMOND
Middle Name:G
Last Name:JONES
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 OLD SMIZER MILL RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3538
Mailing Address - Country:US
Mailing Address - Phone:636-326-4440
Mailing Address - Fax:
Practice Address - Street 1:540 OLD SMIZER MILL RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3538
Practice Address - Country:US
Practice Address - Phone:636-326-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0157781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics