Provider Demographics
NPI:1316145188
Name:JUMP, DONALD R (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:JUMP
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 1:1300 N OAKLAND AVE
Mailing Address - Street 2:STE C
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613
Mailing Address - Country:US
Mailing Address - Phone:417-326-2244
Mailing Address - Fax:417-326-8013
Practice Address - Street 1:1300 N OAKLAND AVE
Practice Address - Street 2:STE C
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613
Practice Address - Country:US
Practice Address - Phone:417-326-2244
Practice Address - Fax:417-326-8013
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0112311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice