Basic Information
| Provider Information | |||||||||
| NPI: | 1366850943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 38717 38TH STREET | ||||||||
| Address2: | US ARMY DENTAL HEALTH ACTIVITY | ||||||||
| City: | FT. GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309055660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067876927 | ||||||||
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| Practice Location | |||||||||
| Address1: | 38717 38TH STREET | ||||||||
| Address2: | US ARMY DENTAL HEALTH ACTIVITY | ||||||||
| City: | FT. GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067876927 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2014 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DN014824 | GA | N | Dental Providers | Dentist | 1223E0200X | DN0014824 | GA | Y | Dental Providers | Dentist | Endodontics |
No ID Information.