Basic Information
Provider Information
NPI: 1346792108
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: ANN
MiddleName: MS
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 960
Address2:  
City: BREMERTON
State: WA
PostalCode: 983370212
CountryCode: US
TelephoneNumber: 3604756728
FaxNumber: 3603732096
Practice Location
Address1: 616 6TH ST
Address2:  
City: BREMERTON
State: WA
PostalCode: 983371420
CountryCode: US
TelephoneNumber: 3603773776
FaxNumber: 3603732096
Other Information
ProviderEnumerationDate: 10/27/2016
LastUpdateDate: 10/28/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X60696958WAY Dental ProvidersDentist 

No ID Information.


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