Provider Demographics
NPI:1588978902
Name:JONES, SHALANE RHEA (DMD)
Entity type:Individual
Prefix:DR
First Name:SHALANE
Middle Name:RHEA
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHALANE
Other - Middle Name:RHEA
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:217 ROBERT MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-6117
Mailing Address - Country:US
Mailing Address - Phone:618-687-3737
Mailing Address - Fax:
Practice Address - Street 1:217 ROBERT MORGAN RD
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-6117
Practice Address - Country:US
Practice Address - Phone:618-687-3737
Practice Address - Fax:618-687-3881
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190284141223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085000735OtherSTATE LICENSE