Provider Demographics
NPI:1306900113
Name:DWIGHT W. JONES, D.M.D., P.A.
Entity type:Organization
Organization Name:DWIGHT W. JONES, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:WILEY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-786-5221
Mailing Address - Street 1:6514 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-2858
Mailing Address - Country:US
Mailing Address - Phone:904-786-5221
Mailing Address - Fax:
Practice Address - Street 1:6514 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2858
Practice Address - Country:US
Practice Address - Phone:904-786-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty