Provider Demographics
NPI:1154429967
Name:JONES, RUSSELL SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:SCOTT
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 1:6390 RUNNYMEADE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8634
Mailing Address - Country:US
Mailing Address - Phone:530-622-6768
Mailing Address - Fax:530-622-9575
Practice Address - Street 1:6390 RUNNYMEADE DR
Practice Address - Street 2:SUITE A
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8634
Practice Address - Country:US
Practice Address - Phone:530-622-6768
Practice Address - Fax:530-622-9575
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC396621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice