Basic Information
Provider Information
NPI: 1629250584
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: JENNIFER
MiddleName: E.
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 19025 WILEYS WELL RD
Address2:  
City: BLYTHE
State: CA
PostalCode: 922252287
CountryCode: US
TelephoneNumber: 7609225300
FaxNumber: 7609229743
Practice Location
Address1: 650 S ZEDIKER AVE
Address2:  
City: PARLIER
State: CA
PostalCode: 936482666
CountryCode: US
TelephoneNumber: 5596466618
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/03/2007
LastUpdateDate: 01/10/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X43023CAY Dental ProvidersDentist 

No ID Information.


Home