Provider Demographics
NPI:1972517688
Name:JONES, WARREN LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:LEE
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:PO BOX 21
Mailing Address - Street 2:912 WEST 12TH STREET
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-0021
Mailing Address - Country:US
Mailing Address - Phone:308-345-1470
Mailing Address - Fax:308-345-2253
Practice Address - Street 1:912 W 12TH ST
Practice Address - Street 2:
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001-2925
Practice Address - Country:US
Practice Address - Phone:308-345-1470
Practice Address - Fax:308-345-2253
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE45541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07823OtherBLUE CROSS PROVIDER NUMBE
NE470-592-257-00Medicaid
KS799607OtherBLUE CROSS PROVIDER NUMBE