Provider Demographics
NPI:1598509705
Name:JONES, STUART SAMUEL (DDS)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:SAMUEL
Last Name:JONES
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 1:329 9TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2002
Mailing Address - Country:US
Mailing Address - Phone:763-226-5598
Mailing Address - Fax:
Practice Address - Street 1:901 NW CARLON AVE APT 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2636
Practice Address - Country:US
Practice Address - Phone:541-389-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist