Provider Demographics
NPI:1811060288
Name:JONES, DAVID THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
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 1:1201 NORTHERN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3001
Mailing Address - Country:US
Mailing Address - Phone:516-869-8215
Mailing Address - Fax:516-627-5258
Practice Address - Street 1:1201 NORTHERN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3001
Practice Address - Country:US
Practice Address - Phone:516-869-8215
Practice Address - Fax:516-627-5258
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY74-3166279OtherTAX ID#