Provider Demographics
NPI:1316945041
Name:JONES, KENNETH MAUGHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MAUGHAN
Last Name:JONES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:M
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2233 WILLAMETTE ST E
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2890
Mailing Address - Country:US
Mailing Address - Phone:541-653-9739
Mailing Address - Fax:541-743-2023
Practice Address - Street 1:2233 WILLAMETTE ST
Practice Address - Street 2:BLDG E
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2890
Practice Address - Country:US
Practice Address - Phone:541-687-4867
Practice Address - Fax:541-686-9620
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist