Provider Demographics
NPI:1285176156
Name:RAYMOND JONE DDS PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RAYMOND JONE DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:JONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-595-0845
Mailing Address - Street 1:6433 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2072
Mailing Address - Country:US
Mailing Address - Phone:650-353-5969
Mailing Address - Fax:
Practice Address - Street 1:6433 MISSION ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2072
Practice Address - Country:US
Practice Address - Phone:650-353-5969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS607341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty