Provider Demographics
NPI:1699893651
Name:JONES, DIANE PATRICE (DMD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:PATRICE
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 LIPSCOMB ST NE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2927
Mailing Address - Country:US
Mailing Address - Phone:321-724-1343
Mailing Address - Fax:321-724-1843
Practice Address - Street 1:4670 LIPSCOMB ST NE
Practice Address - Street 2:SUITE 13
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2927
Practice Address - Country:US
Practice Address - Phone:321-724-1343
Practice Address - Fax:321-724-1843
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10077122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist