Provider Demographics
NPI:1699723544
Name:JONES, ADEEWAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:ADEEWAYNE
Middle Name:
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 1:722 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2736
Mailing Address - Country:US
Mailing Address - Phone:805-525-3001
Mailing Address - Fax:805-525-7468
Practice Address - Street 1:722 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2736
Practice Address - Country:US
Practice Address - Phone:805-525-3001
Practice Address - Fax:805-525-7468
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0156961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB15696-01Medicare ID - Type UnspecifiedMEDI-CAL PROVIDER NUMBER