Basic Information
| Provider Information | |||||||||
| NPI: | 1295022564 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BOONE | ||||||||
| OtherFirstName: | ANNA | ||||||||
| OtherMiddleName: | R. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2911 SOUTH BELT HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | ST. JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645031587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163646444 | ||||||||
| FaxNumber: | 8163646929 | ||||||||
| Practice Location | |||||||||
| Address1: | 2911 SOUTH BELT HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | ST. JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645031587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163646444 | ||||||||
| FaxNumber: | 8163646929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2011 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2011014512 | MO | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 1295022564 | 05 | MO | MEDICAID |